ST. LOUIS JC VAMC (NPI# 1750349429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1750349429 |
| Entity Type | Organization |
| Organization Name | ST. LOUIS JC VAMC |
| Other Organization Name | MARION IL VAMC PHARMACY |
| Practice Address |
2401 W Main St Marion IL 62959-1188 |
| Mailing Address |
Po Box 94462 Cleveland OH 44101-4462 |
| Practice Telephone | 6189975311 |
| Practice Fax Number | 6189978212 |
| Mailing Telephone | 9135784409 |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2020-01-23 |
| Authorized Official Name | ERIN DENISE POTTER (NPI TEAM MEMBER) |
| Authorized Official Telephone | 2023822579 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332100000X | Department of Veterans Affairs (VA) Pharmacy | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | NCPDP# | 1469471 | 01 |
| Other Name | Type Code |
|---|---|
| MARION IL VAMC PHARMACY | Other Name - Individual/Organization |
| MARION VAMC PHARMACY | 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 |
2401 W MAIN ST |
| City | MARION |
| State | IL |
| Zip Code | 62959-1188 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841277696 | Keith D Stewart | Dentist | 2401 W Main St, Marion, IL 62959-1188 | 2005-12-22 |
| 1396353397 | John Gilmore | Nurse Practitioner | 2401 W Main St, Marion, IL 62959-1188 | 2020-07-16 |
| 1083230098 | Samantha Ann Kimble | Social Worker | 2401 W Main St, Marion, IL 62959-1188 | 2020-06-25 |
| 1659907954 | Jason Patton | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-03-18 |
| 1275164543 | Edward Staba | Psychologist | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-27 |
| 1497385918 | Megan Berkel | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2020-01-23 |
| 1699316521 | Angela Trowbridge | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-10-02 |
| 1891346276 | Donna Householder | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1457902918 | Brenda Frazier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| 1043861420 | Michelle Collier | Technician | 2401 W Main St, Marion, IL 62959-1188 | 2019-09-26 |
| Find all providers in the same location | ||||
| 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 | 332100000X |
| Grouping | Suppliers |
| Classification | Department of Veterans Affairs (VA) Pharmacy |
| Department of Veterans Affairs (VA) Pharmacy means any place under VA jurisdiction where drugs are dispensed and Pharmaceutical Care is provided to enrolled Veterans, by licensed pharmacists. The Pharmacy is reviewed by JCAHO, utilizes the VA hospital’s DEA number, and has a designated NCPDP number. VA facility pharmacies include Inpatient (Institutional), Outpatient, Consolidated Mail Outpatient Pharmacies (CMOPs), Research, Addiction Treatment Centers, Long Term Care and Community Based Outpatient Clinics Pharmacies. The VHA Pharmacy Benefits Management - Strategic Healthcare Group has oversight for professional and practice activities of VA Pharmacies. Each pharmacy is under the direct supervision of a U.S. or U.S. territory licensed pharmacist, and has staffing to meet its designated scope of service. |
| Notes: Source: Pharmacy Benefits Management – Strategic Healthcare Group, Veterans Health Administration, Department of Veterans Affairs [1/1/2006: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457309379 | Marion Vamc | Department of Veterans Affairs (VA) Pharmacy | 1700 E 38th St, Marion, IN 46953-4568 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033177589 | Madison Vamc | Department of Veterans Affairs (VA) Pharmacy | 816 Featherstone Rd, Rockford, IL 61107-6300 | 2006-05-03 |
| 1114354537 | Emerling Inc | Department of Veterans Affairs (VA) Pharmacy | 102 W Park St, Taylorville, IL 62568-1547 | 2013-09-30 |
| 1700834116 | Hines Va Cmop | Department of Veterans Affairs (VA) Pharmacy | 5000 S 5th Ave, Bldg. 37, Hines, IL 60141-3030 | 2006-05-05 |
| 1518915172 | Chicago Vamc | Department of Veterans Affairs (VA) Pharmacy | 820 S Damen Ave, Chicago, IL 60612-3728 | 2006-05-05 |
| 1336197284 | Danville Vamc | Department of Veterans Affairs (VA) Pharmacy | 7717 N Orange Prairie Rd, Peoria, IL 61615-9323 | 2006-05-04 |
| 1396793378 | Hines Vamc | Department of Veterans Affairs (VA) Pharmacy | 5000 S 5th Ave, Hines, IL 60141-3030 | 2006-05-04 |
| 1326006933 | James A Lovell Federal Health Care Center | Department of Veterans Affairs (VA) Pharmacy | 3001 Green Bay Rd, North Chicago, IL 60064-3048 | 2006-05-03 |
| 1508824418 | Danville Vamc | Department of Veterans Affairs (VA) Pharmacy | 1900 E Main St, Danville, IL 61832-5100 | 2006-05-02 |
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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.