NPIMap

Organization Active NPI

Salt Lake City Vamc

  • VA Clinic/Center
  • South Jordan, UT
National Provider Identifier
1619113115
Registry record updated Jul 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
SALT LAKE CITY VAMC
Practice address
5119 West Daybreak Parkway
South Jordan, UT 84009-9998
Phone
(913) 578-4409
NPI assigned
Jan 5, 2009
Last updated
Jul 30, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 30, 2021

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

5119 West Daybreak Parkway
South Jordan, UT 84009-9998

Mailing address

PO Box 94463
Cleveland, OH 44101-4463
Phone (913) 578-4409

Other names 1

  • SOUTH JORDAN VA CLINIC Other name

National Provider Directory

National Provider Directory
Tax ID family
Salt Lake City 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

5119 W Daybreak Pkwy
South Jordan, UT 84009
Phone (801) 417-5734

2750 S 5600 W
West Valley City, UT 84120
Phone (801) 417-5732

NPI Registry JSON

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

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627603200000",
    "number": "1619113115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94463",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014463",
            "telephone_number": "913-578-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5119 WEST DAYBREAK PARKWAY",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840099998",
            "telephone_number": "913-578-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SALT LAKE CITY VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2021-07-30",
        "certification_date": "2020-09-29",
        "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": "SOUTH JORDAN VA CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "SOUTH JORDAN VA CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in South Jordan, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2021; 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.