| NAME |
MENOMINEE CBOC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
1110 10TH AVENUE SUITE 101 |
| CITY |
MENOMINEE |
| ZIP |
49858-3058 |
| OFFICIAL VA NAME |
MENOMINEE CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MENOMINEE VA CBOC |
| ST. ADDR. 1 (MAILING) |
1110 10TH AVENUE SUITE 101 |
| CITY (MAILING) |
MENOMINEE |
| STATE (MAILING) |
MICHIGAN |
| ZIP (MAILING) |
49858-3058 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1194763185
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
585GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1194763185
-
- CODING SYSTEM: VASTANUM
- ID: 585GC
-
- CODING SYSTEM: CLIA
- ID: 23D1018227
|
