MEDICARE: MONTANA 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	332100000X	Department of Veterans Affairs (VA) Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2764555	OTHER	MT	NCPDP#

General Provider Information

NPI Number	:	1568410595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANA VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94451
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101-4451
Country	:	US
Telephone Number	:	913-578-4409
Fax Number	:

Provider Business Practice Location Address
First Line	:	1775 SPRING CREEK DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59102-6754
Country	:	US
Telephone Number	:	406-373-3519
Fax Number	:	406-373-3607

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	10/19/2018

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