FAYETTEVILLE 3 VA CLINIC (FAYETTEVILLE VAMC) NPI 1972974392

Clinic/Center (VA) in Fayetteville, NC

NPI 1972974392 Organization Clinic/Center VA CLIA Number 34D2105697 CLIA Certificate of Accreditation

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 NameFAYETTEVILLE 3 VA CLINIC (FAYETTEVILLE VAMC)
Provider Location Address7300 S RAEFORD RD FAYETTEVILLE, NC 28304
Provider Mailing AddressPO BOX 89494 CLEVELAND, OH 44101
NPI Entity TypeOrganization
Is Sole Proprietor?N/A
Is Organization Subpart?No
Other Organization NameFAYETTEVILLE 3 VA CLINIC
Other Name TypeOther Name (5)
Enumeration Date10-12-2015
Last Update Date04-11-2018


Primary Taxonomy

Taxonomy Code261QV0200X
ClassificationClinic/Center
TypeAmbulatory Health Care Facilities
SpecializationVA

Business Address

FAYETTEVILLE 3 VA CLINIC
7300 S RAEFORD RD
FAYETTEVILLE, NC
ZIP 28304
Phone: (828) 257-2333

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Mailing Address

FAYETTEVILLE 3 VA CLINIC
PO BOX 89494
CLEVELAND, OH
ZIP 44101
Phone: (828) 257-2333



Authorized Official

Authorized Official Name ERIN POTTER
Authorized Official TitleNPI TEAM MEMBER
Authorized Official Phone(202) 382-2579

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 Number34D2105697
Facility TypeRURAL HEALTH CLINIC
Certificate TypeCertificate 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
1407891955DR. GEORGE JOHN DEMETRI JR. DPM
Individual
Podiatrist (Foot & Ankle Surgery)7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1740395359DR. GERARD RONEL AIME M.D.
Individual
Family Medicine7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 475-6473
1225333818DR. 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
1881077113DR. ERIN LEE AMADON PHARMD
Individual
Pharmacist (Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist)7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1003036047MRS. 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
1376561571DR. 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
1306224886DR. JAGRUTI PATEL PHARMD
Individual
Pharmacist7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(828) 301-0736
1225431497 STEPHEN GRUVER PHARMD
Individual
Pharmacist7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2121
1790123420DR. KARYN RAY FABO PHARM.D., MBA
Individual
Pharmacist7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1770144677 AMANDA BETH KARELS PHARMD
Individual
Pharmacist7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1396707402MS. 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
1568015964MS. ARLENE RICE RRT-RCP
Individual
Respiratory Therapist, Registered7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 475-6725
1245884428 TERRY MEAD BINKLEY
Individual
Respiratory Therapist, Registered7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1215581491MRS. KELLEY ANDREA WILLIS RCP,RRT
Individual
Respiratory Therapist, Registered7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1730733908 KIM MARIE RUSSELL RRT
Individual
Respiratory Therapist, Registered7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 488-2120
1518950294DR. ROSEMAY MICHEL DPM
Individual
Podiatrist (Foot Surgery)7300 S RAEFORD RD
FAYETTEVILLE, NC 28304
(910) 475-6569
1609875624DR. ERIC WESLEY MILLER M.D.
Individual
Anesthesiology7300 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.