| Organization Name: | IRON MOUNTAIN VAMC |
| NPI Number: | 1114334174 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ERIN POTTER (NPI TEAM MEMBER) |
| Mailing Address: | 813 East Lakeshore Drive Manistique |
| State: | MI US |
| Postal Code: | 498541683 |
| Phone Number: | 6088217200 |
| Fax Number: | |
| NPI Enumeration Date: | 07/22/2014 |
| NPI Last Update Date: | 07/22/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QV0200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | VA |
| Taxonomy Definition: | |