| NAME |
ST. CHARLES MO CBOC |
| STATE |
MISSOURI |
| STREET ADDR. 1 |
2845 VETERANS MEMORIAL PKWY |
| CITY |
SAINT CHARLES |
| ZIP |
63303-3526 |
| OFFICIAL VA NAME |
ST CHARLES VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
ST. CHARLES VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1083654453
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
657GD |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 844 WATERBURY FALLS DR
- CITY (CHANGED FROM): O'FALLON
- STATE (CHANGED FROM): MISSOURI
- ZIP (CHANGED FROM): 63368-2215
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1083654453
-
- CODING SYSTEM: VASTANUM
- ID: 657GD
-
- CODING SYSTEM: CLIA
- ID: 26D0987312
|
