ST. LOUIS JC VAMC (NPI# 1588054738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1588054738 |
| Entity Type | Organization |
| Organization Name | ST. LOUIS JC VAMC |
| Other Organization Name | ENTERPRISE WAY VA CLINIC |
| Practice Address |
1301 Enterprise Way Marion IL 62959-4442 |
| Mailing Address |
Po Box 94462 Cleveland OH 44101-4462 |
| Practice Telephone | 9135784409 |
| Mailing Telephone | 9135784409 |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2018-01-17 |
| Authorized Official Name | ERIN D 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 |
|---|---|
| ENTERPRISE WAY VA CLINIC | Other Name - Individual/Organization |
| 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 |
| 1992067995 | St. Louis Jc Vamc | Clinic/Center | 1130 E Walnut St, Suite 100, Carbondale, IL 62901-5007 | 2012-06-14 |
| 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 |
| Street Address |
1301 ENTERPRISE WAY |
| City | MARION |
| State | IL |
| Zip Code | 62959-4442 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942285572 | Mario L Gospodinoff | Psychiatry & Neurology | 1301 Enterprise Way, Marion, IL 62959-4442 | 2005-12-07 |
| 1679884134 | Sonja Comer | Counselor | 1301 Enterprise Way, Suite 68, Marion, IL 62959-4442 | 2010-06-29 |
| 1679890065 | Katherine Jane Clover | Social Worker | 1301 Enterprise Way, Suite 68, Marion, IL 62959-4442 | 2010-04-26 |
| 1851620827 | Karen K Spilman | Social Worker | 1301 Enterprise Way, Marion, IL 62959-4442 | 2009-12-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710513486 | Sarah Benitone | Counselor | 11264 Il-37, Marion, IL 62959 | 2020-03-13 |
| 1528609328 | Patricia E Murphy | Radiology | 4503 1/2 W Deyoung, Suite 3a, Marion, IL 62959 | 2019-10-02 |
| 1366007007 | Centerstone of Illinois, Inc | Community/Behavioral Health | 202 S Bentley St, Marion, IL 62959 | 2019-05-08 |
| 1649752064 | Sydney Seiter | Occupational Therapist | 906 Skyline Suite 100, Marion, IL 62959 | 2018-09-01 |
| 1497279848 | Brooke Alisa Osman | Licensed Practical Nurse | 11531 Sunderland Road, Marion, IL 62959 | 2017-07-27 |
| 1912436429 | Joy L. Kee | Social Worker | 509 South Bentley Street, Marion, IL 62959 | 2017-06-08 |
| 1386181170 | Susan Smothers | Counselor | 1305 West Main Street, Marion, IL 62959 | 2017-01-31 |
| 1205280922 | Harish Kempegowda | Orthopaedic Surgery | 3331 W Deyoung St Ste 201, Marion, IL 62959 | 2016-04-19 |
| 1942609227 | Casey Hill | Social Worker | 1604 W. Walnut St., Marion, IL 62959 | 2014-08-22 |
| 1306252812 | Justin M White | Chiropractor | 1603 W Kimmel, Marion, IL 62959 | 2014-07-03 |
| Find all providers in zip 62959 | ||||
| Taxonomy Code | 261QV0200X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | VA |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558751776 | St. Louis Jc Vamc | Clinic/Center | 3403 Heartland Street, Marion, IL 62959-6393 | 2015-01-26 |
| 1497143531 | Mountain Home Vamc | Clinic/Center | 4451 Lee Highway, Marion, VA 24354-9998 | 2014-12-23 |
| 1720172174 | Va Hospital - Marion, In | Clinic/Center | 1700 East 38 Street, Marion, IN 46953 | 2006-10-02 |
| 1720035363 | Marion Va Clinic | Clinic/Center | 861 Goolsby St, Marion, VA 24354-1707 | 2006-05-28 |
| 1033302518 | Columbus Va Ambulatory Care Center | Clinic/Center | 1203 Delaware Ave, Corporate Center #2, Marion, OH 43302-6419 | 2007-08-20 |
| 1881623577 | Vamc | Clinic/Center | 2401 W Main St, Marion, IL 62959-1188 | 2006-07-03 |
| 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 |
| 1669860458 | Chicago Vamc | Clinic/Center | 1141 South California Avenue, Chicago, IL 60608-9998 | 2014-12-31 |
| 1992067995 | St. Louis Jc Vamc | Clinic/Center | 1130 E Walnut St, Suite 100, Carbondale, IL 62901-5007 | 2012-06-14 |
| 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 |
| 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.