MEDICARE: PRESCOTT VAMC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QV0200X	VA Clinic/Center

General Provider Information

NPI Number	:	1477504975
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRESCOTT VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94411
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4411
Country	:	US
Telephone Number	:	702-341-3152
Fax Number	:

Provider Business Practice Location Address
First Line	:	41810 N VENTURE DR BLDG B
Second Line	:
City	:	ANTHEM
State	:	AZ
Zip	:	85086-3169
Country	:	US
Telephone Number	:	702-341-3152
Fax Number	:

Authorized Official
Title or Position	:	NPI TEAM MEMBER
Name	:	ERIN POTTER
Credential	:
Telephone Number	:	202-382-2579

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	05/03/2018

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Directions to “PRESCOTT VAMC ” Practice Location

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