NPIMap

Organization Active NPI

Hines Vamc

  • VA Clinic/Center
  • Joliet, IL
National Provider Identifier
1104872761
Registry record updated Feb 23, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
HINES VAMC
Practice address
1201 Eagle Street
Joliet, IL 60432-2031
Phone
(608) 821-7200
Fax
(608) 821-7658
NPI assigned
May 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Erin Potter
Title
Npi Team
Phone
(202) 382-2579

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
VA Clinic/Center 261QV0200X Primary

Addresses

Primary practice location

1201 Eagle Street
Joliet, IL 60432-2031

Mailing address

PO Box 94482
Cleveland, OH 44101-4482
Phone (608) 821-7200

Other names 1

  • Joliet VA CBOC Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0988058Joliet Cboc1201 Eagle Street, Joliet, IL 60432AccreditationMay 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Hines Vamc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1201 Eagle St
Joliet, IL 60432
Phone (815) 740-8100

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677110400000",
    "number": "1104872761",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94482",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014482",
            "telephone_number": "608-821-7200",
            "fax_number": "608-821-7658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 EAGLE STREET",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604322031",
            "telephone_number": "608-821-7200",
            "fax_number": "608-821-7658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HINES VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2023-02-23",
        "certification_date": "2023-02-23",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "NPI TEAM",
        "authorized_official_telephone_number": "202-382-2579"
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Joliet VA CBOC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Joliet VA CBOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.