| NAME |
PRESQUE ISLE VA CLINIC |
| STATE |
MAINE |
| STREET ADDR. 1 |
732 MAIN ST |
| CITY |
PRESQUE ISLE |
| ZIP |
04769-2254 |
| OFFICIAL VA NAME |
PRESQUE ISLE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PRESQUE ISLE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1609829514
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
402GA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 163 VAN BUREN RD #6
- CITY (CHANGED FROM): CARIBOU
- STATE (CHANGED FROM): MAINE
- ZIP (CHANGED FROM): 04736-3567
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1609829514
-
- CODING SYSTEM: VASTANUM
- ID: 402GA
|
