Provider Demographics
NPI:1326201138
Name:MUSKOGEE VAMC
Entity type:Organization
Organization Name:MUSKOGEE VAMC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:NPI TEAM
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-382-2579
Mailing Address - Street 1:PO BOX 94517
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-4517
Mailing Address - Country:US
Mailing Address - Phone:913-578-4409
Mailing Address - Fax:
Practice Address - Street 1:8921 S MINGO RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-5841
Practice Address - Country:US
Practice Address - Phone:918-628-2648
Practice Address - Fax:918-628-2596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-02
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332100000XSuppliersDepartment of Veterans Affairs (VA) Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3724487OtherNCPDP