FAYETTEVILLE 3 VA CLINIC (FAYETTEVILLE VAMC) NPI 1972974392
Clinic/Center (VA) in Fayetteville, NC
About FAYETTEVILLE 3 VA CLINIC (FAYETTEVILLE VAMC)
Fayetteville 3 Va Clinic (fayetteville Vamc) is a provider established in Fayetteville, North Carolina specializing in clinic/center (va) . The NPI number of Fayetteville 3 Va Clinic (fayetteville Vamc) is 1972974392 and was assigned on October 2015. The practitioner's primary taxonomy code is 261QV0200X. The provider is registered as an organization and their NPI record was last updated 4 years ago. The provider's other name is Fayetteville 3 Va Clinic. The authorized official of this NPI record is Erin Potter (Npi Team Member)
The CLIA number of Fayetteville 3 Va Clinic is 34D2105697 registered as a "rural health clinic" facility with a CLIA Certificate of Accreditation. This is a CLIA certificate is issued to Fayetteville 3 Va Clinic on the basis of the laboratory's accreditation by an accreditation organization approved by CMS. This type of certificate is issued to a laboratories tha perform nonwaived (moderate and/or high complexity) testing.
NPI | 1972974392 |
Provider Name | FAYETTEVILLE 3 VA CLINIC (FAYETTEVILLE VAMC) |
Provider Location Address | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 |
Provider Mailing Address | PO BOX 89494 CLEVELAND, OH 44101 |
NPI Entity Type | Organization |
Is Sole Proprietor? | N/A |
Is Organization Subpart? | No |
Other Organization Name | FAYETTEVILLE 3 VA CLINIC |
Other Name Type | Other Name (5) |
Enumeration Date | 10-12-2015 |
Last Update Date | 04-11-2018 |
Primary Taxonomy
Taxonomy Code | 261QV0200X |
Classification | Clinic/Center |
Type | Ambulatory Health Care Facilities |
Specialization | VA |
Business Address
FAYETTEVILLE 3 VA CLINIC
7300 S RAEFORD RD
FAYETTEVILLE, NC
ZIP 28304
Phone: (828) 257-2333
Mailing Address
FAYETTEVILLE 3 VA CLINIC
PO BOX 89494
CLEVELAND, OH
ZIP 44101
Phone: (828) 257-2333
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for the NPI number 1972974392 is:
CLIA Number | 34D2105697 |
Facility Type | RURAL HEALTH CLINIC |
Certificate Type | Certificate of Accreditation |
Other Providers at the same location
The following 20 providers are registered at the same or nearby location.
NPI | Name / Type | Taxonomy | Address |
---|---|---|---|
1407891955 | DR. GEORGE JOHN DEMETRI JR. DPM Individual | Podiatrist (Foot & Ankle Surgery) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1740395359 | DR. GERARD RONEL AIME M.D. Individual | Family Medicine | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6473 |
1225333818 | DR. JUSTIN EDWARD ADAMS PHARM.D., M.B.A. Individual | Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1881077113 | DR. ERIN LEE AMADON PHARMD Individual | Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1003036047 | MRS. SEKEYA EDREEKIA DURGAN NP Individual | Nurse Practitioner (Family) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6244 |
1093220642 | CONNIE BAXTER FNP Individual | Nurse Practitioner (Family) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1376561571 | DR. SUSANNAH OGUNWO MD Individual | Family Medicine (Geriatric Medicine) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1154499267 | VIKAS M VIRKUD MD,FACC Individual | Internal Medicine (Cardiovascular Disease) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1306224886 | DR. JAGRUTI PATEL PHARMD Individual | Pharmacist | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (828) 301-0736 |
1225431497 | STEPHEN GRUVER PHARMD Individual | Pharmacist | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2121 |
1790123420 | DR. KARYN RAY FABO PHARM.D., MBA Individual | Pharmacist | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1770144677 | AMANDA BETH KARELS PHARMD Individual | Pharmacist | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1396707402 | MS. MARY ANN REYNOLDS ANP-C Individual | Nurse Practitioner (Adult Health) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6412 |
1598929747 | YVONNE WELEDJI NGALE Individual | Internal Medicine (Endocrinology, Diabetes & Metabolism) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6412 |
1568015964 | MS. ARLENE RICE RRT-RCP Individual | Respiratory Therapist, Registered | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6725 |
1245884428 | TERRY MEAD BINKLEY Individual | Respiratory Therapist, Registered | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1215581491 | MRS. KELLEY ANDREA WILLIS RCP,RRT Individual | Respiratory Therapist, Registered | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1730733908 | KIM MARIE RUSSELL RRT Individual | Respiratory Therapist, Registered | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
1518950294 | DR. ROSEMAY MICHEL DPM Individual | Podiatrist (Foot Surgery) | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 475-6569 |
1609875624 | DR. ERIC WESLEY MILLER M.D. Individual | Anesthesiology | 7300 S RAEFORD RD FAYETTEVILLE, NC 28304 (910) 488-2120 |
NPI Footnotes
What is the National Provider Indentifier (NPI)?
The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider Location Address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
Entity Type Code
The code describing the type of health care provider that is being assigned an NPI.
The entity type codes are:
1 = Person: individual human being who furnishes health care;
2 = Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Subparts are the components and separate physical locations of organization health care providers. Subpart examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Provider Other Organization Name
The other organization name is the alternative last name by which the provider is or has been known (if an individual) or other name by which the organization provider is or has been known. The code identifying the type of other name. The provider other organization name codes are:
1 = former name;
2 = professional name;
3 = doing business as (d/b/ a) name;
4 = former legal business name; :
5 = other.
Provider Enumeration Date
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date
The date that a NPI record was last updated or changed.
Primary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
Authorized Official Name
The name of the person authorized to submit the NPI application or to officially change data for a health care provider.