BRIDGEPORT VA CLINIC (1336) INSTITUTION (4)

Name	Value
NAME	BRIDGEPORT VA CLINIC
STATE	TEXAS
STREET ADDR. 1	408 PARK WEST CT
CITY	DECATUR
ZIP	76234-3263
OFFICIAL VA NAME	BRIDGEPORT VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 17 PARENT FACILITY PARENT OF ASSOCIATION: DALLAS VA MEDICAL CENTER
BILLING FACILITY NAME	DECATUR VA CLINIC
EFFECTIVE DATE/TIME	2007-01-08 00:00:00 STATUS: ACTIVE NPI: 1568417087
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	549GE
IDENTIFIER	CODING SYSTEM: NPI ID: 1568417087 CODING SYSTEM: VASTANUM ID: 549GE