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ROOSEVELT VA CLINIC
NPI 1124062898
Clinic/Center - VA in Roosevelt, UT

Active since June 15, 2006CLIA 46D2019240 · Accreditation
245 W 200 N, ROOSEVELT, UT 84066(913) 578-4409 Get Directions Write a Review

NPPES record last updated: January 17, 2018. Verified against the NPPES registry weekly; last sync: September 13, 2026.

Record update history: Jan 17, 2018, Mar 1, 2017 (2 updates tracked since 2017).

About Roosevelt Va Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

ROOSEVELT VA CLINIC (NPI 1124062898) is a healthcare organization registered as a va in Roosevelt, Utah and active in the NPI registry since June 2006. The organization holds an CLIA Accreditation certificate valid through September 30, 2026 and lists Erin Potter, Npi Team Member, as its authorized official.

NPPES Registry Identity

NPI1124062898
Entity TypeOrganization
Primary Taxonomy261QV0200X
Legal Business NameSALT LAKE CITY VAMC
Location Address245 W 200 NRoosevelt, UT 84066-2740
Mailing AddressPo Box 94463Cleveland, OH 44101-4463 · (913) 578-4409
Phone(913) 578-4409
Organization SubpartNo
Authorized OfficialErin PotterNpi Team Member · (202) 382-2579
Enumeration DateJune 15, 2006
Last NPPES UpdateJanuary 17, 20182 updates tracked since enumeration
✔ NPI 1124062898 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · VAAmbulatory Health Care Facilities
Taxonomy Code261QV0200X
245 W 200 N, Roosevelt, UT 84066
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Other Names 1

Other NameRoosevelt Va Clinic

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Accreditation 46D2019240

Roosevelt VA Cboc · Roosevelt, UT
Active · expires Sep 30, 2026
CLIA Number46D2019240
Laboratory TypeCommunity Clinic
Certificate Effective DateJanuary 25, 2011
Certificate Expiration DateSeptember 30, 2026
Laboratory DirectorKane Walsh
Laboratory Phone(801) 582-1565
Laboratory LocationRoosevelt VA Cboc245 West 200 North, Roosevelt, UT 84066
CLIA data matches this NPI record on: Address
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Salt Lake City Vamc's NPI number?

The NPI number for Salt Lake City Vamc is 1124062898. It was assigned to this organization in the NPPES registry on June 15, 2006. The provider is also known as Roosevelt VA Clinic.

Where is Salt Lake City Vamc located?

Salt Lake City Vamc is located at 245 W 200 N, Roosevelt, UT 84066. The listed phone number is (913) 578-4409.

What is Salt Lake City Vamc's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in VA, with taxonomy code 261QV0200X.

Does Salt Lake City Vamc hold a CLIA laboratory certificate?

Yes. A Certificate of Accreditation (number 46D2019240) is associated with this NPI, valid through September 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Salt Lake City Vamc was last updated on January 17, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.