# SALT LAKE CITY VAMC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** SOUTH JORDAN VA CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619113115
- **Authorized official:** ERIN POTTER (NPI TEAM MEMBER)
- **Authorized official phone:** (202) 382-2579

## Contact information

- **Practice address:** 5119 WEST DAYBREAK PARKWAY, SOUTH JORDAN, UT 84009-9998
- **Practice address phone:** (913) 578-4409
- **Mailing address:** PO BOX 94463, CLEVELAND, OH 44101-4463
- **Mailing address phone:** (913) 578-4409

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QV0200X | VA Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 01/05/2009
- **Last updated:** 07/30/2021