| NAME |
FORT PIERCE VA CLINIC |
| STATE |
FLORIDA |
| STREET ADDR. 1 |
1901 SOUTH 25TH STREET |
| STREET ADDR. 2 |
SUITE 103 |
| CITY |
FT PIERCE |
| ZIP |
34947-4711 |
| OFFICIAL VA NAME |
FORT PIERCE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
FORT PIERCE VA CBOC |
| ST. ADDR. 1 (MAILING) |
1901 SOUTH 25TH STREET |
| ST. ADDR. 2 (MAILING) |
SUITE 103 |
| CITY (MAILING) |
FT PIERCE |
| STATE (MAILING) |
FLORIDA |
| ZIP (MAILING) |
34947-4711 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1699728683
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
548GA |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1699728683
-
- CODING SYSTEM: VASTANUM
- ID: 548GA
|
