| NAME |
SPRINGFIELD VA CLINIC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
5850 S 6TH ST FRONTAGE RD EAST #A |
| CITY |
SPRINGFIELD |
| ZIP |
62703-5162 |
| OFFICIAL VA NAME |
SPRINGFIELD VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
SPRINGFIELD VA CBOC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1235177973
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
550GD |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1235177973
-
- CODING SYSTEM: VASTANUM
- ID: 550GD
-
- CODING SYSTEM: CLIA
- ID: 14D0998867
|
