| NAME |
MAPLEWOOD CBOC |
| STATE |
MINNESOTA |
| STREET ADDR. 1 |
3100 KENNARD ST STE 100 |
| CITY |
MAPLEWOOD |
| ZIP |
55109-5466 |
| OFFICIAL VA NAME |
ST. PAUL (CBOC) |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MAPLEWOOD VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1659328292
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
618GD |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1725 LEGACY PARKWAY, SUITE #100
- CITY (CHANGED FROM): MAPLEWOOD
- STATE (CHANGED FROM): MINNESOTA
- ZIP (CHANGED FROM): 55109-5432
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1659328292
-
- CODING SYSTEM: VASTANUM
- ID: 618GD
-
- CODING SYSTEM: CLIA
- ID: 24D1016446
|
