ST. LOUIS JC VAMC


Address: 1130 E Walnut St, Suite 100, Carbondale, IL 62901-5007
Phone: 9135784409

ST. LOUIS JC VAMC (NPI# 1992067995) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1992067995
Entity Type Organization
Organization Name ST. LOUIS JC VAMC
Other Organization Name CARBONDALE VA CBOC
Practice Address 1130 E Walnut St
Suite 100
Carbondale
IL 62901-5007
Mailing Address Po Box 94462
Cleveland
OH 44101-4462
Practice Telephone 9135784409
Mailing Telephone 9135784409
Enumeration Date 2012-06-14
Last Update Date 2018-01-17
Authorized Official Name MS. ERIN POTTER (NPI TEAM MEMBER)
Authorized Official Telephone 2023822579
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QV0200X Clinic/Center
Specialization: VA
Ambulatory Health Care Facilities

Other Provider/Organization Names

Other Name Type Code
Carbondale VA CBOC Other Name - Individual/Organization

Other Provider IDs and Locations

NPI Name Taxonomy Address Enumeration
1114317369 St. Louis Jc Vamc Clinic/Center 2600 Washington Boulevard, St. Louis, MO 63103-1420 2015-01-27
1396135513 St. Louis Jc Vamc Clinic/Center 3615 Olive Street, St. Louis, MO 63108-3604 2015-01-26
1558751776 St. Louis Jc Vamc Clinic/Center 3403 Heartland Street, Marion, IL 62959-6393 2015-01-26
1497012652 St. Louis Jc Vamc Clinic/Center 608 Rollie Moore Drive, Harrisburg, IL 62946-9998 2012-04-12
1902198922 St. Louis Jc Vamc Clinic/Center 1627 A Roy Dr, Washington, MO 63090-5008 2011-05-10
1619116399 St. Louis Jc Vamc Clinic/Center 1253 Paris Rd, Suite A, Mayfield, KY 42066-4989 2009-02-19
1518155878 St. Louis Jc Vamc Clinic/Center 6854 Parker Rd, Florissant, MO 63033-5313 2007-10-11
1578616892 St. Louis Jc Vamc Clinic/Center 99 Stagecoach Rd, Madisonville, KY 42431-8009 2007-01-19
1902840622 St. Louis Jc Vamc Clinic/Center 4105 N Water Tower Pl, Mount Vernon, IL 62864-6296 2006-06-15
1508809948 St. Louis Jc Vamc Clinic/Center 2420 Linwood Dr, Suite 3, Paragould, AR 72450-6122 2006-06-14

Office Location

Street Address 1130 E WALNUT ST
SUITE 100
City CARBONDALE
State IL
Zip Code 62901-5007

Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1558961268 Gerad Aaron Harsy Pharmacist Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 2020-10-30
1437708674 Board of Trustees of Southern Illinois University Clinic/Center 300 W Oak Street, Carbondale, IL 62901 2019-09-10
1306317383 Rachael O Johnson Nurse Practitioner 404 S. Lewis Ln, Carbondale, IL 62901 2018-12-17
1740795194 Megan Marie Zimmerman Nurse Practitioner 1100 W Diann Ln., Carbondale, IL 62901 2017-12-07
1295244242 Amy Elizabeth Prudencio Social Worker 1301 E. Walnut Street, Carbondale, IL 62901 2017-09-21
1740708171 Theresa Aleise Goodin Speech-Language Pathologist 1301 East Walnut Street, Carbondale, IL 62901 2017-09-06
1144762527 Kathleen Chwalisz Rigney Psychologist 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 2016-11-16
1285185173 Shawnee Health Service and Development Corp Social Worker 404 S. Lewis Lane, Carbondale, IL 62901 2016-10-17
1437605094 Arielle Greer Nurse's Aide 510 E. Russell St., A, Carbondale, IL 62901 2016-09-01
1518413863 Complete Family Eyecare of Carbondale, PC Optometrist 1241 East Walnut Street, Carbondale, IL 62901 2016-08-28
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Taxonomy Information

Taxonomy Code 261QV0200X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization VA

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1609426709 Danville Vamc Clinic/Center 207 E Hamilton Rd, Bloomington, IL 61704-7527 2019-09-19
1437636966 Miracle Healthcare LLC Clinic/Center 2024 Hickory Rd Ste 306, Homewood, IL 60430 2018-07-26
1558751776 St. Louis Jc Vamc Clinic/Center 3403 Heartland Street, Marion, IL 62959-6393 2015-01-26
1669860458 Chicago Vamc Clinic/Center 1141 South California Avenue, Chicago, IL 60608-9998 2014-12-31
1497012652 St. Louis Jc Vamc Clinic/Center 608 Rollie Moore Drive, Harrisburg, IL 62946-9998 2012-04-12
1851660724 Omaha Vamc Clinic/Center 406 Avenue C, Sterling, IL 61081-3407 2011-12-22
1902840622 St. Louis Jc Vamc Clinic/Center 4105 N Water Tower Pl, Mount Vernon, IL 62864-6296 2006-06-15
1629016845 Omaha Vamc Clinic/Center 6020 Broadway St, Quincy, IL 62305-7919 2006-06-02
1902843360 Oak Park Va Clinic Clinic/Center 149 S Oak Park Ave, Oak Park, IL 60302-2901 2006-06-02
1154368710 Hines Vamc Clinic/Center 10201 S Cicero Ave, Oak Lawn, IL 60453-4023 2006-06-01
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Competitor

Search similar providers

City CARBONDALE
Zip Code 62901

Improve Information

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Dataset Information

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.

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