| NAME |
ST. CLAIR CNTY VA CLINIC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
1190 FORTUNE BOULEVARD |
| CITY |
SHILOH |
| ZIP |
62269-7358 |
| OFFICIAL VA NAME |
ST. CLAIR CNTY VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
SHILOH VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1154374429
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
657GA |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1154374429
-
- CODING SYSTEM: VASTANUM
- ID: 657GA
-
- CODING SYSTEM: CLIA
- ID: 14D0998710
|
