| NAME |
BRAINERD CBOC |
| STATE |
MINNESOTA |
| STREET ADDR. 1 |
722 NW 7th STREET |
| CITY |
BRAINERD |
| ZIP |
56401-2912 |
| OFFICIAL VA NAME |
BRAINERD VA COMMUNITY OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BRAINERD VA CBOC |
| ST. ADDR. 1 (MAILING) |
722 NW 7th STREET |
| CITY (MAILING) |
BRAINERD |
| STATE (MAILING) |
MINNESOTA |
| ZIP (MAILING) |
56401-2912 |
| EFFECTIVE DATE/TIME |
-
- 2007-03-15 00:00:00
- STATUS: ACTIVE
- NPI: 1871640839
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
656GA |
| IDENTIFIER |
-
- CODING SYSTEM: VASTANUM
- ID: 656GA
-
- CODING SYSTEM: CLIA
- ID: 24D0998789
|
