NPIMap

Organization Active NPI

St. Louis JC Vamc

  • VA Clinic/Center
  • Carbondale, IL
National Provider Identifier
1992067995
Registry record updated Jan 17, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
VA Clinic/CenterTaxonomy code 261QV0200X
Legal business name
ST. LOUIS JC VAMC
Practice address
1130 E Walnut St
Suite 100
Carbondale, IL 62901-5007
Phone
(913) 578-4409
NPI assigned
Jun 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. 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

1130 E Walnut St
Suite 100
Carbondale, IL 62901-5007

Mailing address

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

Other names 1

  • Carbondale 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
14D2043807Carbondale Cboc1130 E Walnut Street, Carbondale, IL 62901AccreditationMay 22, 2026

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

1130 E Walnut St
Ste 100
Carbondale, IL 62901
Phone (618) 351-1031

NPI Registry JSON

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

{
    "created_epoch": "1339632000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516147200000",
    "number": "1992067995",
    "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": "1130 E WALNUT ST",
            "address_2": "SUITE 100",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629015007",
            "telephone_number": "913-578-4409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. LOUIS JC VAMC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-06-14",
        "last_updated": "2018-01-17",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QV0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, VA",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carbondale VA CBOC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2018; 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.