FAYETTEVILLE VAMC (NPI# 1134473440) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134473440 |
| Entity Type | Organization |
| Organization Name | FAYETTEVILLE VAMC |
| Other Organization Name | SPRINGFIELD VA CBOC |
| Practice Address |
1100 N College Ave Fayetteville AR 72703-1944 |
| Mailing Address |
Po Box 94494 Cleveland OH 44101 |
| Practice Telephone | 6153553451 |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2017-09-26 |
| Authorized Official Name | ERIN POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QV0200X |
Clinic/Center Specialization: VA |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Springfield VA CBOC | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992264824 | Fayetteville Vamc | Clinic/Center | 3015 Connecticut Ave, Joplin, MO 64804-3035 | 2019-03-19 |
| 1659879138 | Fayetteville Vamc | Clinic/Center | 4 Josh Ct, Jacksonville, NC 28546-0052 | 2018-01-30 |
| 1194256362 | Fayetteville Vamc | Clinic/Center | 4101 Raeford Road, Suite 100-b, Fayetteville, NC 28304-4114 | 2017-03-21 |
| 1528456811 | Fayetteville Vamc | Clinic/Center | 216 East Township Street, Fayetteville, AR 72703-2818 | 2015-01-08 |
| 1124422308 | Fayetteville Vamc | Clinic/Center | 306 Brynn Marr Rd, Jacksonville, NC 28546-7023 | 2014-10-16 |
| 1962819052 | Fayetteville Vamc | Clinic/Center | 18 Doctors Cir Ste 2, Supply, NC 28462-4089 | 2014-07-21 |
| 1114270212 | Fayetteville Vamc | Clinic/Center | 3112 Tramway Road, Sanford, NC 27332-9998 | 2012-10-26 |
| 1912201146 | Fayetteville Vamc | Clinic/Center | 139 Three Hunts Drive, Pembroke, NC 28372-6800 | 2011-01-03 |
| 1831415751 | Fayetteville Vamc | Clinic/Center | 2713 W Commercial St, Ozark, AR 72949-3409 | 2010-04-16 |
| 1568417798 | Fayetteville Vamc | Clinic/Center | 4006 Henderson Drive, Jacksonville, NC 28546-9998 | 2006-05-24 |
| Street Address |
1100 N COLLEGE AVE |
| City | FAYETTEVILLE |
| State | AR |
| Zip Code | 72703-1944 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265435697 | Randall B Davis | Specialist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2005-05-31 |
| 1548870462 | Anna Parker | Pharmacist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-08-05 |
| 1912522095 | Shan M Khan | Dentist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-06-14 |
| 1760003495 | Andrea G. Burnett | Respiratory Therapist, Registered | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-05-05 |
| 1396366092 | Robin Elizabeth Bush | Respiratory Therapist, Registered | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-05-04 |
| 1295356186 | Brock Helfrich | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1999 | 2020-05-01 |
| 1285255661 | Curtis Deon Burnley Jr. | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-27 |
| 1871113878 | Katherine Lynn Horn | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-20 |
| 1649890930 | William Colton Cheek | Optometrist | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-04-16 |
| 1487285995 | Kristen Schatzman | Social Worker | 1100 N College Ave, Fayetteville, AR 72703-1944 | 2020-02-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477154391 | Margaret Sorrells | Pharmacist | 3909 N Mall Ave Attn:pharmacy, Fayetteville, AR 72703 | 2020-11-06 |
| 1497369631 | Justin A Rand | Massage Therapist | 88 W Colt Square Dr, Fayetteville, Ar 72703, Fayetteville, AR 72703 | 2020-09-04 |
| 1235777558 | Washington Regional Medical System | Specialist | 3264 N North Hills Blvd, Fayetteville, AR 72703 | 2019-12-17 |
| 1760024582 | Haley Brooke Thompson | Occupational Therapist | 2474 E Joyce Blvd Ste 2, Null, Fayetteville, AR 72703 | 2019-10-14 |
| 1306492129 | Bhg L, LLC | Clinic/Center | 8 Colt Square Drive, Fayetteville, AR 72703 | 2019-08-16 |
| 1306406269 | Idell Marie Mitchell | Optometrist | Eye Clinic, 1100 N College Ave, Fayetteville, AR 72703 | 2019-06-13 |
| 1821574815 | Toni Myer | Nurse Practitioner | 3 E Appleby Rd Ste 101, Fayetteville, AR 72703 | 2018-07-13 |
| 1306340393 | Josh Kelfer | Student in an Organized Health Care Education/Training Program | 1125 North College Avenue, Fayetteville, AR 72703 | 2018-03-22 |
| 1649726449 | Vantage Point of Nwa | Community/Behavioral Health | 4171 N. Crossover Rd, Fayetteville, AR 72703 | 2016-08-31 |
| 1386097137 | Jason Nordstrom | Speech-Language Pathologist | 2664 N Valencia Ave, Fayetteville, AR 72703 | 2016-07-18 |
| Find all providers in zip 72703 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194256362 | Fayetteville Vamc | Clinic/Center | 4101 Raeford Road, Suite 100-b, Fayetteville, NC 28304-4114 | 2017-03-21 |
| 1528456811 | Fayetteville Vamc | Clinic/Center | 216 East Township Street, Fayetteville, AR 72703-2818 | 2015-01-08 |
| 1649721309 | Fayetteville Vamc | Clinic/Center | 2300 Ramsey Street, Fayetteville, NC 28301-3856 | 2016-10-18 |
| 1972974392 | Fayetteville Vamc | Clinic/Center | 7300 S Raeford Rd, Fayetteville, NC 28304-6162 | 2015-10-12 |
| 1437547726 | Fayetteville Vamc | Clinic/Center | 180 E Sunbridge Dr, Fayetteville, AR 72703-2830 | 2015-01-08 |
| 1457759615 | Fayetteville Vamc | Clinic/Center | 2300 Ramsey St, Fayetteville, NC 28301-3856 | 2014-12-19 |
| 1801294145 | Fayetteville Vamc | Clinic/Center | 2301 Robeson St, Fayetteville, NC 28305-5640 | 2014-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073821518 | Little Rock Vamc | Clinic/Center | 1520 E Dave Ward Dr, Conway, AR 72032-9649 | 2010-09-17 |
| 1831415751 | Fayetteville Vamc | Clinic/Center | 2713 W Commercial St, Ozark, AR 72949-3409 | 2010-04-16 |
| 1649401316 | Memphis Vamc | Clinic/Center | 125 Quarles Ln, West Helena, AR 72390-1923 | 2009-07-29 |
| 1508809948 | St. Louis Jc Vamc | Clinic/Center | 2420 Linwood Dr, Suite 3, Paragould, AR 72450-6122 | 2006-06-14 |
| 1417996489 | Shreveport Vamc | Clinic/Center | 910 Realtor Road, Texarkana, AR 71854-1020 | 2006-06-05 |
| 1063450617 | Little Rock Vamc | Clinic/Center | 759 Highway 62 E, Suite 331, Mountain Home, AR 72653-3260 | 2006-06-04 |
| 1861439697 | Little Rock Vamc | Clinic/Center | 300 Morrow St S, Mena, AR 71953 | 2006-06-01 |
| 1619923398 | Memphis Vamc | Clinic/Center | 2908 S Caraway Rd Ste B, Jonesboro, AR 72401-7306 | 2006-05-25 |
| 1215982582 | Little Rock Vamc | Clinic/Center | 177 Sawtooth Oak St, Hot Springs, AR 71901-7160 | 2006-05-24 |
| 1215980164 | Little Rock Vamc | Clinic/Center | 1702 N West Ave, El Dorado, AR 71730 | 2006-05-19 |
| Find all providers with the same taxonomy | ||||
| City | FAYETTEVILLE |
| Zip Code | 72703 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.