| NAME |
ROOSEVELT VA CLINIC |
| STATE |
UTAH |
| STREET ADDR. 1 |
245 WEST 200 NORTH |
| CITY |
ROOSEVELT |
| ZIP |
84066-2740 |
| OFFICIAL VA NAME |
ROOSEVELT VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
ROOSEVELT VA CLINIC |
| ST. ADDR. 1 (MAILING) |
245 WEST 200 NORTH |
| CITY (MAILING) |
ROOSEVELT |
| STATE (MAILING) |
UTAH |
| ZIP (MAILING) |
84066-2740 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1124062898
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
660GD |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1124062898
-
- CODING SYSTEM: VASTANUM
- ID: 660GD
-
- CODING SYSTEM: CLIA
- ID: 46D2019240
|
