Provider Demographics
NPI:1699029025
Name:ALTOONA VAMC
Entity Type:Organization
Organization Name:ALTOONA VAMC
Other - Org Name:INDIANA 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 94430
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4430
Mailing Address - Country:US
Mailing Address - Phone:717-277-6568
Mailing Address - Fax:
Practice Address - Street 1:1570 OAKLAND AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-2429
Practice Address - Country:US
Practice Address - Phone:717-277-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-07
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA