QUINCY CBOC (1659) INSTITUTION (4)

Name	Value
NAME	QUINCY CBOC
STATE	ILLINOIS
STREET ADDR. 1	6020 BROADWAY STREET
CITY	QUINCY
ZIP	62305-7919
OFFICIAL VA NAME	QUINCY COMMUNITY BASED OUTPATIENT CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 23 PARENT FACILITY PARENT OF ASSOCIATION: IOWA CITY HCS
BILLING FACILITY NAME	QUINCY VA CLINIC
ST. ADDR. 1 (MAILING)	721 BROADWAY
CITY (MAILING)	QUINCY
STATE (MAILING)	ILLINOIS
ZIP (MAILING)	62301-2708
EFFECTIVE DATE/TIME	2007-01-08 00:00:00 STATUS: ACTIVE NPI: 1629016845
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	636GG
HISTORY	EFFECTIVE DATE: 2000-07-01 00:00:00 REALIGNED FROM: ZZ QUINCY CBOC
IDENTIFIER	CODING SYSTEM: NPI ID: 1629016845 CODING SYSTEM: VASTANUM ID: 636GG CODING SYSTEM: CLIA ID: 14D1002372