MEDICARE: IRON MOUNTAIN 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	:	1518588284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRON MOUNTAIN VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94484
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4484
Country	:	US
Telephone Number	:	608-821-7200
Fax Number	:	608-821-7658

Provider Business Practice Location Address
First Line	:	2001 MINNEAPOLIS AVE
Second Line	:
City	:	GLADSTONE
State	:	MI
Zip	:	49837-2060
Country	:	US
Telephone Number	:	608-821-7200
Fax Number	:	608-821-7658

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

Provider Enumeration Date	:	05/04/2020
Last Update Date	:	02/23/2023

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Directions to “IRON MOUNTAIN VAMC ” Practice Location

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