St. Louis Jc Vamc

NPI #1558751776 in Marion, Illinois

Provider Information

NPI Number: 1558751776
Entity Type: Organization
Organization Name: St. Louis Jc Vamc
Primary Specialty: Clinic/Center - VA
Enumeration Date: Jan 26, 2015
Last Updated: Jan 17, 2018

Practice Location

Address: 3403 HEARTLAND STREET
City: Marion
State: Illinois
ZIP Code: 62959-6393
Phone: (913) 578-4409

Authorized Official

Name: ERIN D 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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