| NAME |
GAYLORD OUTPATIENT CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
2782 S OTSEGO AVE |
| CITY |
GAYLORD |
| ZIP |
49735-9404 |
| OFFICIAL VA NAME |
Gaylord VA Outpatient Clinic |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
GAYLORD VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1003869843
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
655GA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 2782 SOUTH OTSEGO AVENUE
- CITY (CHANGED FROM): GAYLORD
- STATE (CHANGED FROM): MICHIGAN
- ZIP (CHANGED FROM): 49735-9998
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1003869843
-
- CODING SYSTEM: VASTANUM
- ID: 655GA
-
- CODING SYSTEM: CLIA
- ID: 23D1048371
|
