St. Louis Jc Vamc

NPI #1154374429 in Shiloh, Illinois

Provider Information

NPI Number: 1154374429
Entity Type: Organization
Organization Name: St. Louis Jc Vamc
Primary Specialty: Clinic/Center - VA
Enumeration Date: May 18, 2006
Last Updated: Jul 6, 2018

Practice Location

Address: 1190 FORTUNE BLVD
City: Shiloh
State: Illinois
ZIP Code: 62269
Phone: (913) 578-4409

Authorized Official

Name: ERIN POTTER
Title: NPI TEAM MEMBER
Phone: (202) 382-2579

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - VA — VA	261QV0200X	Primary

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