| NAME |
PONTIAC VA CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
44200 WOODWARD AVE STE 212 |
| CITY |
PONTIAC |
| ZIP |
48341-5045 |
| OFFICIAL VA NAME |
PONTIAC VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PONTIAC VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1609815034
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
553GB |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 44200 WOODWARD AVENUE SUITE 208
- CITY (CHANGED FROM): PONTIAC
- STATE (CHANGED FROM): MICHIGAN
- ZIP (CHANGED FROM): 48341-3412
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1609815034
-
- CODING SYSTEM: VASTANUM
- ID: 553GB
-
- CODING SYSTEM: CLIA
- ID: 23D1048374
|
