| NAME |
GREENVILLE |
| STATE |
MISSISSIPPI |
| STREET ADDR. 1 |
1651 HIGHWAY 1 S STE 1D |
| CITY |
GREENVILLE |
| ZIP |
38701-7803 |
| OFFICIAL VA NAME |
GREENVILLE |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
GREENVILLE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1043250418
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
586GC |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1502 S COLORADO ST
- CITY (CHANGED FROM): GREENVILLE
- STATE (CHANGED FROM): MISSISSIPPI
- ZIP (CHANGED FROM): 38703-7219
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1043250418
-
- CODING SYSTEM: VASTANUM
- ID: 586GC
|
