| NAME |
FAIRBANKS VA CLINIC |
| STATE |
ALASKA |
| STREET ADDR. 1 |
2555 PHILLIPS FIELD RD |
| CITY |
FAIRBANKS |
| ZIP |
99709-3933 |
| OFFICIAL VA NAME |
FAIRBANKS VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
FAIRBANKS VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1619922812
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
ALASKA |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
463GA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 4076 NEELY ROAD, ROOM 1J-101
- CITY (CHANGED FROM): FT WAINWRIGHT
- STATE (CHANGED FROM): ALASKA
- ZIP (CHANGED FROM): 99703-8424
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1619922812
-
- CODING SYSTEM: VASTANUM
- ID: 463GA
-
- CODING SYSTEM: CLIA
- ID: 02D2245629
|
