1417345398 NPI number — ANN ARBOR VAMC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417345398 NPI number — ANN ARBOR VAMC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANN ARBOR VAMC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417345398
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 94472
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44101-4472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-821-7200
Provider Business Mailing Address Fax Number:
608-821-7658

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3800 PACKARD ST
Provider Second Line Business Practice Location Address:
SUITE 120 AND 130
Provider Business Practice Location Address City Name:
ANN ARBOR
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48108-2073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-821-7200
Provider Business Practice Location Address Fax Number:
608-821-7658
Provider Enumeration Date:
12/31/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POTTER
Authorized Official First Name:
ERIN
Authorized Official Middle Name:
Authorized Official Title or Position:
NPI TEAM
Authorized Official Telephone Number:
202-382-2579

Provider Taxonomy Codes

  • Taxonomy code: 261QV0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)