MEDICARE: AMARILLO 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	4530336	OTHER	TX	NCPDP#

General Provider Information

NPI Number	:	1750339636
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMARILLO VAMC

Provider Business Mailing Address
First Line	:	PO BOX 94400
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44101
Country	:	US
Telephone Number	:	615-355-3451
Fax Number	:

Provider Business Practice Location Address
First Line	:	3510 4TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79415-9998
Country	:	US
Telephone Number	:	806-472-3458
Fax Number	:	806-472-3401

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/31/2024

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