| NAME |
ZZ-WILDER ORC |
| STATE |
VERMONT |
| STREET ADDR. 1 |
34 DEPOT ST |
| CITY |
WILDER |
| ZIP |
05088 |
| OFFICIAL VA NAME |
QUITING TIME CLINIC, WILDER VT. |
| INACTIVE FACILITY FLAG |
INACTIVE |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
WILDER VA CBOC |
| ST. ADDR. 1 (MAILING) |
34 DEPOT ST |
| CITY (MAILING) |
WILDER |
| STATE (MAILING) |
VERMONT |
| ZIP (MAILING) |
05088 |
| EFFECTIVE DATE/TIME |
-
- 2007-03-26 00:00:00
- STATUS: ACTIVE
- NPI: 1861436966
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
405HG |
| IDENTIFIER |
-
- CODING SYSTEM: VASTANUM
- ID: 405HG
|
