Basic Information
| Provider Information | |||||||||
| NPI: | 1720653306 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RICHMOND VAMC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 89464 | ||||||||
| Address2: | |||||||||
| City: | CLEVELAND | ||||||||
| State: | OH | ||||||||
| PostalCode: | 441016464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282572333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4830 SOUTHPOINT DR | ||||||||
| Address2: | |||||||||
| City: | FREDERICKSBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 224072606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282572333 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2021 | ||||||||
| LastUpdateDate: | 05/25/2021 | ||||||||
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| AuthorizedOfficialLastName: | POTTER | ||||||||
| AuthorizedOfficialFirstName: | ERIN | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | NPI TEAM LEAD | ||||||||
| AuthorizedOfficialTelephone: | 2023822579 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QV0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | VA |
No ID Information.