NPIMap

Organization Active NPI

St. Louis JC Vamc

  • VA Clinic/Center
  • Mount Vernon, IL
National Provider Identifier
1902840622
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
ST. LOUIS JC VAMC
Practice address
4000 S Water Tower PL
Mount Vernon, IL 62864-9998
Phone
(913) 578-4409
NPI assigned
Jun 15, 2006
Last updated
Apr 5, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

4000 S Water Tower PL
Mount Vernon, IL 62864-9998

Mailing address

PO Box 94462
Cleveland, OH 44101-4462
Phone (913) 578-4409

Other names 1

  • MT. VERNON VA CLINIC Other name

National Provider Directory

National Provider Directory
Tax ID family
St Louis JC Vamc45 organizations share this tax ID, including this one

Other organizations with this tax ID 44

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

View all 44

Locations

4000 S Water Tower Pl
Mount Vernon, IL 62864
Phone (618) 246-2910

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1902840622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 94462",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441014462",
            "telephone_number": "913-578-4409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 S WATER TOWER PL",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628649998",
            "telephone_number": "913-578-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS JC VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-15",
        "last_updated": "2022-04-05",
        "certification_date": "2022-03-24",
        "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": "MT. VERNON VA CLINIC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MT. VERNON VA CLINIC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.