| NAME |
LASALLE CBOC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
4461 PROGRESS BLVD |
| CITY |
PERU |
| ZIP |
61354-1109 |
| OFFICIAL VA NAME |
LASSALLE CBOC (578GF) |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PERU VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1639125479
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
578GF |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 4461 N PROGRESS VILLAGE
- CITY (CHANGED FROM): PERU
- STATE (CHANGED FROM): ILLINOIS
- ZIP (CHANGED FROM): 61354-1109
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1639125479
-
- CODING SYSTEM: VASTANUM
- ID: 578GF
-
- CODING SYSTEM: CLIA
- ID: 14D1016781
|
