St. Louis Jc Vamc

NPI #1497012652 in Harrisburg, Illinois

Provider Information

NPI Number: 1497012652
Entity Type: Organization
Organization Name: St. Louis Jc Vamc
Primary Specialty: Clinic/Center - VA
Enumeration Date: Apr 12, 2012
Last Updated: Jan 17, 2018

Practice Location

Address: 608 ROLLIE MOORE DRIVE
City: Harrisburg
State: Illinois
ZIP Code: 62946-9998
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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