Provider Demographics
NPI:1518355650
Name:MONTGOMERY VAMC
Entity Type:Organization
Organization Name:MONTGOMERY VAMC
Other - Org Name:DOTHAN 1 VA CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:NPI TEAM MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-382-2579
Mailing Address - Street 1:PO BOX 89470
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-6470
Mailing Address - Country:US
Mailing Address - Phone:828-257-2333
Mailing Address - Fax:
Practice Address - Street 1:3753 ROSS CLARK CIRCLE
Practice Address - Street 2:SUITE 4
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-2291
Practice Address - Country:US
Practice Address - Phone:828-257-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA