| NAME |
NORTHWEST VA CLINIC |
| STATE |
ARIZONA |
| STREET ADDR. 1 |
13985 W. GRAND AVE SUITE #101 |
| CITY |
SUN CITY |
| ZIP |
85374-3626 |
| OFFICIAL VA NAME |
NORTHWEST VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
SUN CITY VA CBOC |
| ST. ADDR. 1 (MAILING) |
13985 WEST GRAND AVE SUITE 101 |
| CITY (MAILING) |
SURPRISE |
| STATE (MAILING) |
ARIZONA |
| ZIP (MAILING) |
85382-3646 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1598704512
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| TIMEZONE EXCEPTION |
SST Only |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
644GA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 13985 W GRAND AVE #101
- CITY (CHANGED FROM): SUN CITY
- STATE (CHANGED FROM): ARIZONA
- ZIP (CHANGED FROM): 85374-3626
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1598704512
-
- CODING SYSTEM: VASTANUM
- ID: 644GA
-
- CODING SYSTEM: CLIA
- ID: 03D1002389
|
