STATE COLLEGE VA CLINIC (1123)    INSTITUTION (4)

Name Value
NAME STATE COLLEGE VA CLINIC
STATE PENNSYLVANIA
STREET ADDR. 1 2581 CLYDE AVE
CITY STATE COLLEGE
ZIP 16801-9998
OFFICIAL VA NAME STATE COLLEGE VA CLINIC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME STATE COLLEGE VA CLINIC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1134168032
  • 2015-03-03 00:00:00
    STATUS:   ACTIVE
    NPI:   1134168032
TAXONOMY CODE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 503GC
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1134168032
  • CODING SYSTEM:   VASTANUM
    ID:   503GC
  • CODING SYSTEM:   CLIA
    ID:   39D1002304