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CARBONDALE VA CBOC
NPI 1992067995
Clinic/Center - VA in Carbondale, IL

Active since June 14, 2012
1130 E WALNUT ST, SUITE 100, CARBONDALE, IL 62901(913) 578-4409 Get Directions Write a Review

NPPES record last updated: January 17, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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

About Carbondale Va Cboc NPPES

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

CARBONDALE VA CBOC (NPI 1992067995) is a healthcare organization registered as a va in Carbondale, Illinois and active in the NPI registry since June 2012. The organization lists Erin Potter, Npi Team Member, as its authorized official.

NPPES Registry Identity

NPI1992067995
Entity TypeOrganization
Primary Taxonomy261QV0200X
Legal Business NameST. LOUIS JC VAMC
Location Address1130 E WALNUT ST, SUITE 100Carbondale, IL 62901-5007
Mailing AddressPo Box 94462Cleveland, OH 44101-4462 · (913) 578-4409
Phone(913) 578-4409
Organization SubpartNo
Authorized OfficialErin PotterNpi Team Member · (202) 382-2579
Enumeration DateJune 14, 2012
Last NPPES UpdateJanuary 17, 20182 updates tracked since enumeration
✔ NPI 1992067995 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · VAAmbulatory Health Care Facilities
Taxonomy Code261QV0200X
1130 E WALNUT ST, Carbondale, IL 62901
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Other Names 1

Other NameCarbondale Va Cboc

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JOHN ALAN LONGMIRE
Technician, Health Information
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
DESTINY ROSE COTY LSW
Social Worker
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (309) 264-4638
MR. PHILLIP LYNN EASTON SR. R.N.
Registered Nurse
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
JESSICA CAROL PIND LPN
Licensed Practical Nurse
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
NATASHA MARSHALL
Registered Nurse
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
MISS MEEKA KAY PENNINGTON
Technician, Health Information
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
MRS. DEBRA G. TRAVELSTEAD RN
Registered Nurse
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031
MRS. GABRIELLE BRIANNE MONIGER AMSA
Technician, Health Information
1130 E WALNUT ST
CARBONDALE, IL 62901
Jackson County (618) 351-1031

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 St. Louis Jc Vamc's NPI number?

The NPI number for St. Louis Jc Vamc is 1992067995. It was assigned to this organization in the NPPES registry on June 14, 2012. The provider is also known as Carbondale VA Cboc.

Where is St. Louis Jc Vamc located?

St. Louis Jc Vamc is located at 1130 E Walnut St Suite 100, Carbondale, IL 62901. The listed phone number is (913) 578-4409.

What is St. Louis Jc Vamc's specialty?

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

When was this NPI record last updated?

The NPPES record for St. Louis Jc 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.