NPIMap

Organization Active NPI

Fayetteville Vamc

  • VA Clinic/Center
  • Springfield, MO
National Provider Identifier
1417900671
Registry record updated Jan 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
FAYETTEVILLE VAMC
Practice address
1850 W Republic Rd
Springfield, MO 65807-5730
Phone
(615) 355-3451
NPI assigned
May 18, 2006
Last updated
Jan 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2019

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

1850 W Republic Rd
Springfield, MO 65807-5730

Mailing address

PO Box 94494
Cleveland, OH 44101
Phone (615) 355-3451

Other names 2

  • Mount Vernon VA CBOC Other name
  • SPRINGFIELD VA CLINIC Other name

National Provider Directory

National Provider Directory
Tax ID family
Fayetteville Vamc15 organizations share this tax ID, including this one

Other organizations with this tax ID 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1147910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548115200000",
    "number": "1417900671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94494",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44101",
            "telephone_number": "615-355-3451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 W REPUBLIC RD",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658075730",
            "telephone_number": "615-355-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-18",
        "last_updated": "2019-01-22",
        "status": "A",
        "authorized_official_last_name": "POTTER",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "NPI TEAM MEMBER",
        "authorized_official_telephone_number": "202-382-2579"
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mount Vernon VA CBOC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SPRINGFIELD VA CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.