| NAME |
GALESBURG CBOC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
310 HOME BOULEVARD |
| CITY |
GALESBURG |
| ZIP |
61401-9998 |
| OFFICIAL VA NAME |
GALESBURG COMMUNITY BASED OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
GALESBURG VA CBOC |
| ST. ADDR. 1 (MAILING) |
310 HOME BOULEVARD |
| CITY (MAILING) |
GALESBURG |
| STATE (MAILING) |
ILLINOIS |
| ZIP (MAILING) |
61401-9998 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1629022108
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
636GI |
| HISTORY |
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1629022108
-
- CODING SYSTEM: VASTANUM
- ID: 636GI
-
- CODING SYSTEM: CLIA
- ID: 14D1003137
|
