| NAME |
DUBUQUE CBOC |
| STATE |
IOWA |
| STREET ADDR. 1 |
2600 DODGE ST, SUITE A1 |
| CITY |
DUBUQUE |
| ZIP |
52003-7159 |
| OFFICIAL VA NAME |
DUBUQUE COMMUNITY BASED OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
DUBUQUE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1346293818
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
636GJ |
| HISTORY |
-
- EFFECTIVE DATE: 2000-07-01 00:00:00
- REALIGNED FROM: ZZ DUBUQUE CBOC
-
- STREET ADDR. 1 (CHANGED FROM): 2600 DODGE ST, SUITE A1
- CITY (CHANGED FROM): DUBUQUE
- STATE (CHANGED FROM): IOWA
- ZIP (CHANGED FROM): 52003-7159
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1346293818
-
- CODING SYSTEM: VASTANUM
- ID: 636GJ
-
- CODING SYSTEM: CLIA
- ID: 16D1002368
|
