| NAME |
BEAVER DAM, WI CBOC |
| STATE |
WISCONSIN |
| STREET ADDR. 1 |
215 CORPORATE DRIVE, SUITE B |
| CITY |
BEAVER DAM |
| ZIP |
53916-3123 |
| OFFICIAL VA NAME |
BEAVER DAM, WI CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BEAVER DAM VA CBOC |
| ST. ADDR. 1 (MAILING) |
215 CORPORATE DRIVE, SUITE B |
| CITY (MAILING) |
BEAVER DAM |
| STATE (MAILING) |
WISCONSIN |
| ZIP (MAILING) |
53916-3123 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1992758254
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
607GE |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1992758254
-
- CODING SYSTEM: VASTANUM
- ID: 607GE
-
- CODING SYSTEM: CLIA
- ID: 52D1016786
|
