LACROSSE CBOC (1820)    INSTITUTION (4)

Name Value
NAME LACROSSE CBOC
STATE WISCONSIN
STREET ADDR. 1 4000 STATE ROAD 16
CITY LACROSSE
ZIP 54601-1809
OFFICIAL VA NAME LACROSSE CBOC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME LACROSSE VA CLINIC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1104873298
TAXONOMY CODE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 676GC
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1104873298
  • CODING SYSTEM:   VASTANUM
    ID:   676GC
  • CODING SYSTEM:   CLIA
    ID:   52D1012361