NPIMap

Organization Active NPI

Fayetteville Vamc

  • VA Clinic/Center
  • Branson, MO
National Provider Identifier
1609024058
Registry record updated Sep 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
FAYETTEVILLE VAMC
Practice address
5571 N Gretna Rd
Branson, MO 65616-7287
Phone
(615) 355-3451
NPI assigned
Aug 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2017

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 Primary

Addresses

Primary practice location

5571 N Gretna Rd
Branson, MO 65616-7287

Mailing address

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

Other names 1

  • Branson 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
26D1089219Branson Cboc5571 Gretna Rd, Branson, MO 65616AccreditationMay 22, 2026

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": "1219881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1506384000000",
    "number": "1609024058",
    "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": "5571 N GRETNA RD",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656167287",
            "telephone_number": "615-355-3451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTEVILLE VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-28",
        "last_updated": "2017-09-26",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Branson VA CBOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Branson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2017; 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.