| NAME |
ST. JAMES VA CLINIC |
| STATE |
MINNESOTA |
| STREET ADDR. 1 |
1103 13TH AVE SOUTH |
| CITY |
ST. JAMES |
| ZIP |
56081-9998 |
| OFFICIAL VA NAME |
SOUTH CENTRAL CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
ST. JAMES VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1518905074
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
618GA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1212 HECKMAN COURT
- CITY (CHANGED FROM): ST. JAMES
- STATE (CHANGED FROM): MINNESOTA
- ZIP (CHANGED FROM): 56081-8702
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1518905074
-
- CODING SYSTEM: VASTANUM
- ID: 618GA
|
