FAYETTEVILLE VAMC (NPI# 1962819052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1962819052 |
| Entity Type | Organization |
| Organization Name | FAYETTEVILLE VAMC |
| Other Organization Name | SUPPLY VA CLINIC |
| Practice Address |
18 Doctors Cir Ste 2 Supply NC 28462-4089 |
| Mailing Address |
Po Box 89494 Cleveland OH 44101-6494 |
| Practice Telephone | 8282572333 |
| Mailing Telephone | 8282572333 |
| Enumeration Date | 2014-07-21 |
| 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 |
|---|---|
| SUPPLY 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 |
| 1114270212 | Fayetteville Vamc | Clinic/Center | 3112 Tramway Road, Sanford, NC 27332-9998 | 2012-10-26 |
| 1912201146 | Fayetteville Vamc | Clinic/Center | 139 Three Hunts Drive, Pembroke, NC 28372-6800 | 2011-01-03 |
| 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 |
18 DOCTORS CIR STE 2 |
| City | SUPPLY |
| State | NC |
| Zip Code | 28462-4089 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558910943 | Lisa M Jock | Technician | 1276 Skipper Run Sw, Supply, NC 28462 | 2019-09-09 |
| 1023532686 | Novant Health Brunswick Endoscopy Center, LLC | Nurse Anesthetist, Certified Registered | 13 Medical Campus Drive, Suite 101, Supply, NC 28462 | 2017-07-26 |
| 1821510579 | Novant Health Brunswick Endoscopy Center, LLC | Clinic/Center | 13 Medical Campus Dr, Suite 101, Supply, NC 28462 | 2017-07-14 |
| 1831461920 | Reginald Lofton Hewett | Counselor | 1473 Cedar Grove Rd, Supply, NC 28462 | 2012-02-03 |
| 1760793343 | Coastal Hearing Centers, Inc | Clinic/Center | 2298 Ocean Hwy, Supply, NC 28462 | 2010-06-29 |
| 1083943567 | Lorell Sneeden Pait | Nurse Practitioner | 795 Ocean Highway West, Supply, NC 28462 | 2009-12-14 |
| 1043451321 | Well Care Home Care | Home Health | 118 Ocean Highway West, Supply, NC 28462 | 2009-03-16 |
| 1467672873 | South Atlantic Radiation Oncology, LLC | Clinic/Center | 545 Ocean Highway West, Supply, NC 28462 | 2007-04-26 |
| 1225177702 | Barbara C Bauer | Counselor | 1041 Old Ocean Highway, Supply, NC 28462 | 2007-02-05 |
| 1891852323 | Liberty Medical Specialties, Inc | Durable Medical Equipment & Medical Supplies | 1120 Ocean Hwy West, Supply, NC 28462 | 2007-01-03 |
| Find all providers in zip 28462 | ||||
| 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 |
| 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 |
| 1912201146 | Fayetteville Vamc | Clinic/Center | 139 Three Hunts Drive, Pembroke, NC 28372-6800 | 2011-01-03 |
| 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.