| NAME |
WATERLOO CBOC |
| STATE |
IOWA |
| STREET ADDR. 1 |
4000 UNIVERSITY AVE STE 100 |
| CITY |
WATERLOO |
| ZIP |
50701-5656 |
| OFFICIAL VA NAME |
WATERLOO COMMUNITY BASED OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
WATERLOO VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1134169592
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
636GH |
| HISTORY |
-
- EFFECTIVE DATE: 2000-07-01 00:00:00
- REALIGNED FROM: ZZ WATERLOO CBOC
-
- STREET ADDR. 1 (CHANGED FROM): 945 TOWER PARK DRIVE
- CITY (CHANGED FROM): WATERLOO
- STATE (CHANGED FROM): IOWA
- ZIP (CHANGED FROM): 50701-3500
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1134169592
-
- CODING SYSTEM: VASTANUM
- ID: 636GH
-
- CODING SYSTEM: CLIA
- ID: 16D1002370
|
