PORT JERVIS (1569)    INSTITUTION (4)

Name Value
NAME PORT JERVIS
STATE NEW YORK
STREET ADDR. 1 100 PIKE STREET
CITY PORT JERVIS
ZIP 12771-1831
OFFICIAL VA NAME PORT JERVIS
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME PORT JERVIS VA CLINIC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1104863760
TAXONOMY CODE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 620GE
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1104863760
  • CODING SYSTEM:   VASTANUM
    ID:   620GE
  • CODING SYSTEM:   CLIA
    ID:   130626403