NPIMap

Organization Active NPI

Fargo Vamc

  • VA Clinic/Center
  • Fargo, ND
National Provider Identifier
1194358739
Registry record updated Apr 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
FARGO VAMC
Practice address
721 1St Ave N
Fargo, ND 58102-4903
Phone
(913) 578-4409
Fax
(913) 578-4536
NPI assigned
Feb 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 27, 2020

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

721 1St Ave N
Fargo, ND 58102-4903

Mailing address

PO Box 94452
Cleveland, OH 44101-4452
Phone (913) 578-4409

Other names 1

  • FARGO VA CLINIC 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
35D2191755North Fargo VA Clinic (CRRC)721 1St Ave N, Fargo, ND 58102AccreditationMay 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fargo Vamc13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

721 1st Ave N
Fargo, ND 58102
Phone (701) 461-7330

NPI Registry JSON

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

{
    "created_epoch": "1582243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1587945600000",
    "number": "1194358739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94452",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014452",
            "telephone_number": "913-578-4409",
            "fax_number": "913-578-4536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "721 1ST AVE N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581024903",
            "telephone_number": "913-578-4409",
            "fax_number": "913-578-4536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FARGO VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-21",
        "last_updated": "2020-04-27",
        "certification_date": "2020-04-27",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_middle_name": "DENISE",
        "authorized_official_title_or_position": "NPI TEAM LEAD",
        "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": "FARGO VA CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "FARGO VA CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2020; 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.