FAYETTEVILLE VAMC (NPI# 1568417798) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568417798 |
| Entity Type | Organization |
| Organization Name | FAYETTEVILLE VAMC |
| Other Organization Name | JACKSONVILLE 1 VA CLINIC |
| Practice Address |
4006 Henderson Drive Jacksonville NC 28546-9998 |
| Mailing Address |
Po Box 89494 Cleveland OH 44101-6494 |
| Practice Telephone | 8282573777 |
| Mailing Telephone | 8282572333 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-04-11 |
| 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 |
|---|---|
| JACKSONVILLE 1 VA CLINIC | 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 |
| 1538799002 | Fayetteville Vamc | Clinic/Center | 2580 Henderson Dr, Jacksonville, NC 28546-5252 | 2020-01-23 |
| Street Address |
4006 HENDERSON DRIVE |
| City | JACKSONVILLE |
| State | NC |
| Zip Code | 28546-9998 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912420282 | Silvia Ivette Love | Counselor | 4006 Henderson Drive, Jacksonville, NC 28546 | 2017-07-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316578388 | Judylyn Hobson | Registered Nurse | Pride In North Carolina, LLC, 3886 Henderson Dr, Jacksonville, NC 28546 | 2020-01-29 |
| 1427694637 | Aaron Patrick Bettcher | Military Health Care Provider | 3rd Mrb Loop Rd, Camp Lejeune, NC 28546 | 2019-11-22 |
| 1962044289 | Levi Scott Marshall | Military Health Care Provider | Everett Creek Road, Building 612, Camp Lejeune, NC 28546 | 2019-10-09 |
| 1649826652 | Nicholas Otazo | Military Health Care Provider | 3rd Mrb 20073, Camp Lejeune, NC 28546 | 2019-08-15 |
| 1417519570 | Publix North Carolina, Lp | Durable Medical Equipment & Medical Supplies | 2001 Marlin Drive Unit 100, Jacksonville, NC 28546 | 2019-06-28 |
| 1023500212 | Josip Ninrodriguez | Military Health Care Provider | 3d Marine Raider Battaliom, Camp Lejeune, NC 28546 | 2018-06-04 |
| 1639661192 | Kenneth Lee Russell | Military Health Care Provider | 3d Marine Raider Battalion, Camp Lejeune, NC 28546 | 2018-05-31 |
| 1346730173 | Coastal Foot Center, LLC | Clinic/Center | 29 Office Park Dr Ste B, Jacksonville, NC 28546 | 2018-05-17 |
| 1578080271 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 380 Western Blvd, Jacksonville, NC 28546 | 2017-08-24 |
| 1144757493 | Darin Lee Peterson | Specialist/Technologist | G644 Camp Geiger, School of Infantry-east, Jacksonville, NC 28546 | 2017-05-17 |
| Find all providers in zip 28546 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659879138 | Fayetteville Vamc | Clinic/Center | 4 Josh Ct, Jacksonville, NC 28546-0052 | 2018-01-30 |
| 1124422308 | Fayetteville Vamc | Clinic/Center | 306 Brynn Marr Rd, Jacksonville, NC 28546-7023 | 2014-10-16 |
| 1083961007 | Cindy Arlene Jones | Clinic/Center | 155 Scenic Rd, Jacksonville, AL 36265-8251 | 2012-08-09 |
| 1538799002 | Fayetteville Vamc | Clinic/Center | 2580 Henderson Dr, Jacksonville, NC 28546-5252 | 2020-01-23 |
| 1821464314 | Gainesville Vamc | Clinic/Center | 3901 University Blvd. South, Jacksonville, FL 32216-4312 | 2015-08-19 |
| 1649678988 | Gainesville Vamc | Clinic/Center | 6900 Southpoint Dr N, Jacksonville, FL 32216-8007 | 2014-12-19 |
| 1447472758 | Health Care Consultants | Clinic/Center | 1833 Boulevard, Jacksonville, FL 32206 | 2007-05-03 |
| 1578506655 | Gainesville Vamc | Clinic/Center | 1536 N Jefferson St, Jacksonville, FL 32209-6525 | 2006-06-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003446105 | Durham Vamc | Clinic/Center | 11618 Us 70 Business Highway West, Suites 100 and 200, Clayton, NC 27520-2275 | 2020-01-17 |
| 1194256362 | Fayetteville Vamc | Clinic/Center | 4101 Raeford Road, Suite 100-b, Fayetteville, NC 28304-4114 | 2017-03-21 |
| 1457719312 | Salisbury Vamc | Clinic/Center | 3506 W Tyvola Road, Charlotte, NC 28208-9998 | 2016-02-08 |
| 1609274943 | Durham Vamc | Clinic/Center | 8081 Arco Corporate Dr, Suite 103, Raleigh, NC 27617-2041 | 2014-12-19 |
| 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 |
| 1174800585 | Hampton Vamc | Clinic/Center | 1845 West City Drive, Elizabeth City, NC 27909-9633 | 2011-11-14 |
| 1912201146 | Fayetteville Vamc | Clinic/Center | 139 Three Hunts Drive, Pembroke, NC 28372-6800 | 2011-01-03 |
| 1811225428 | Asheville Vamc | Clinic/Center | 2270 College Ave Ste 145, Forest City, NC 28043-2459 | 2009-11-20 |
| 1073557559 | Salisbury Vamc | Clinic/Center | 1695 Kernersville Medical Parkway, Kernersville, NC 27284-7159 | 2006-06-15 |
| Find all providers with the same taxonomy | ||||
| City | JACKSONVILLE |
| Zip Code | 28546 |
Please comment or provide details below to improve the information on FAYETTEVILLE VAMC.
| 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.