NPIMap

Organization Active NPI

San Francisco Vamc

  • VA Clinic/Center
  • Clearlake, CA
National Provider Identifier
1689976094
Registry record updated Nov 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
SAN FRANCISCO VAMC
Practice address
15145 Lakeshore Dr
Clearlake, CA 95422-8106
Phone
(702) 341-3020
NPI assigned
Nov 18, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 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

15145 Lakeshore Dr
Clearlake, CA 95422-8106

Mailing address

PO Box 94417
Cleveland, OH 44101-4417
Phone (702) 341-3020

Other names 1

  • Clearlake 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
05D2017138Clearlake VA Cboc15145 Lakeshore Drive, Clearlake, CA 95422AccreditationMay 22, 2026

National Provider Directory

National Provider Directory
Tax ID family
San Francisco Vamc17 organizations share this tax ID, including this one

Other organizations with this tax ID 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1290038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1509494400000",
    "number": "1689976094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94417",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014417",
            "telephone_number": "702-341-3020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15145 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228106",
            "telephone_number": "702-341-3020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN FRANCISCO VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-18",
        "last_updated": "2017-11-01",
        "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": "Clearlake VA CBOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clearlake, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.