Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
VA |
261QV0200X |
| NPI # | 1033512983 |
| LBN Legal business name | ST. LOUIS JC VAMC |
| Authorized official | ERIN POTTER - (NPI TEAM MEMBER) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | 10/07/2014 |
| Last updated | 01/17/2018 - About 8 years ago |
| Identifiers | n/a |
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