FAYETTEVILLE VAMC (NPI# 1912201146) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912201146 |
| Entity Type | Organization |
| Organization Name | FAYETTEVILLE VAMC |
| Other Organization Name | PEMBROKE VA CLINIC |
| Practice Address |
139 Three Hunts Drive Pembroke NC 28372-6800 |
| Mailing Address |
Po Box 89494 Cleveland OH 44101-6494 |
| Practice Telephone | 8282573777 |
| Mailing Telephone | 8282572333 |
| Enumeration Date | 2011-01-03 |
| 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 |
|---|---|
| PEMBROKE 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 |
| 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 |
| 1538799002 | Fayetteville Vamc | Clinic/Center | 2580 Henderson Dr, Jacksonville, NC 28546-5252 | 2020-01-23 |
| Street Address |
139 THREE HUNTS DRIVE |
| City | PEMBROKE |
| State | NC |
| Zip Code | 28372-6800 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558962977 | Kayla J Oxendine | Counselor | 86 Threehunts Drive, Pembroke, NC 28372 | 2020-11-03 |
| 1720688401 | Melissa Claire Kratz | Pharmacist | 930 Hwy 711 East, Pembroke, NC 28372 | 2020-10-30 |
| 1841775681 | Nikki Locklear | Counselor | 86 Three Hunts Dr., Pembroke, NC 28372 | 2018-09-27 |
| 1043703218 | Julie Anne Harrison-swartz | Nurse Practitioner | Uncp Student Health, 113 Hawk Drive, Pembroke, NC 28372 | 2018-06-12 |
| 1134627508 | William Dixon | Specialist/Technologist | One University Drive, Pembroke, NC 28372 | 2018-01-31 |
| 1740796291 | A Primary Choice, Inc. | In Home Supportive Care | 208 Union Chapel Road, Suite D, Pembroke, NC 28372 | 2017-12-20 |
| 1578924130 | William Joshua Johnson | Nurse Practitioner | 3334 Moss Neck Road, Pembroke, NC 28372 | 2016-03-10 |
| 1831560234 | Sungjun Jung | Pharmacist | 930 Nc Hwy 711 E, Pembroke, NC 28372 | 2015-10-12 |
| 1154715027 | Lilly Marie Shorter | Counselor | 86 Three Hunt Drive, Pembroke, NC 28372 | 2015-03-27 |
| 1487046728 | Eye Heart You Home Health, LLC | Public Health or Welfare | 925 University Road, Pembroke, NC 28372 | 2015-02-24 |
| Find all providers in zip 28372 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| 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 |
| 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 |
| 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 |
| 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 |
| 1174800585 | Hampton Vamc | Clinic/Center | 1845 West City Drive, Elizabeth City, NC 27909-9633 | 2011-11-14 |
| 1811225428 | Asheville Vamc | Clinic/Center | 2270 College Ave Ste 145, Forest City, NC 28043-2459 | 2009-11-20 |
| Find all providers with the same taxonomy | ||||
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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.