| NAME |
JANESVILLE, WI CBOC |
| STATE |
WISCONSIN |
| STREET ADDR. 1 |
1141 BLACK BRIDGE RD |
| CITY |
JANESVILLE |
| ZIP |
53545-1092 |
| OFFICIAL VA NAME |
JANESVILLE, WI CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
JANESVILLE VA CLINIC |
| ST. ADDR. 1 (MAILING) |
2419 MORSE STREET |
| CITY (MAILING) |
JANESVILLE/ |
| STATE (MAILING) |
WISCONSIN |
| ZIP (MAILING) |
53545-0221 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1124074810
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
607GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1124074810
-
- CODING SYSTEM: VASTANUM
- ID: 607GC
-
- CODING SYSTEM: CLIA
- ID: 52D1091528
|
