Madison Vamc

Primary specialty

VA Clinic/CenterTaxonomy code 261QV0200X

Legal business name

MADISON VAMC

Practice address

750 Kiwanis Dr
Suite 250
Freeport, IL 61032-7119

Phone

(608) 821-7200

NPI assigned

Jan 19, 2007

Last updated

Sep 4, 2015By the provider in NPPES

Organization subpart

No

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

Addresses

Other names 1

• Freeport VA CBOC Other name

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

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441324800000",
    "number": "1558414987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5117",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537050117",
            "telephone_number": "608-821-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "750 KIWANIS DR",
            "address_2": "SUITE 250",
            "city": "FREEPORT",
            "state": "IL",
            "postal_code": "610327119",
            "telephone_number": "608-821-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADISON VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2015-09-04",
        "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": "Freeport VA CBOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Janise Lucas
• Duane A. Ludwig, DMD
• Heather Lutz, FNP-BC
• Suzanne M Lyons, PTA
• Jeffrey Thomas Lyrenmann, ATC, CSCS, PES
• Edward D Maglietta, MD
• Magna Medical Solutions (Midwest Mobile Imaging)
• Malcolm Eaton Enterprises
• Madhusudan R Malladi, MD
• Julie Marcure, LMT

• VA Clinic/Center in Freeport, IL
• Providers in Freeport, IL by specialty
• VA Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2015; 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.