| NAME |
PORT CHARLOTTE VA CLINIC |
| STATE |
FLORIDA |
| STREET ADDR. 1 |
4161 TAMIAMI TRAIL, UNIT 401 |
| CITY |
PORT CHARLOTTE |
| ZIP |
33952-9204 |
| OFFICIAL VA NAME |
PORT CHARLOTTE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PORT CHARLOTTE VA CBOC |
| ST. ADDR. 1 (MAILING) |
4161 TAMIAMI TRAIL, UNIT 401 |
| CITY (MAILING) |
PORT CHARLOTTE |
| STATE (MAILING) |
FLORIDA |
| ZIP (MAILING) |
33952-9204 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1649219031
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
516GE |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1649219031
-
- CODING SYSTEM: VASTANUM
- ID: 516GE
-
- CODING SYSTEM: CLIA
- ID: 10D0999475
|
