| NAME |
KANKAKEE COUNTY CBOC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
581 WILLIAM LATHAM DR |
| CITY |
BOURBONNAIS |
| ZIP |
60914-2317 |
| OFFICIAL VA NAME |
KANKAKEE COUNTY CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BOURBONNAIS VA CBOC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1780631317
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
578GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1780631317
-
- CODING SYSTEM: VASTANUM
- ID: 578GC
-
- CODING SYSTEM: CLIA
- ID: 14D1016773
|
