| NAME |
BROOKSVILLE CBOC |
| STATE |
FLORIDA |
| STREET ADDR. 1 |
14540 CORTEZ BLVD STE 108 |
| CITY |
BROOKSVILLE |
| ZIP |
34613-6056 |
| OFFICIAL VA NAME |
BROOKSVILLE CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BROOKSVILLE VA CBOC |
| ST. ADDR. 1 (MAILING) |
14540 CORTEZ BLVD STE 108 |
| CITY (MAILING) |
BROOKSVILLE |
| STATE (MAILING) |
FLORIDA |
| ZIP (MAILING) |
34613-6056 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1437100179
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
673GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1437100179
-
- CODING SYSTEM: VASTANUM
- ID: 673GC
-
- CODING SYSTEM: CLIA
- ID: 10D1001498
|
