| NAME |
LEWISTON VA CLINIC |
| STATE |
IDAHO |
| STREET ADDR. 1 |
1630 23RD AVE, SUITE 302 & 401, BLDG 2 |
| CITY |
LEWISTON |
| ZIP |
83501-6350 |
| OFFICIAL VA NAME |
LEWISTON VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
LEWISTON VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1630 23RD AVE, SUITE 302 & 401, BLDG 2 |
| CITY (MAILING) |
LEWISTON |
| STATE (MAILING) |
IDAHO |
| ZIP (MAILING) |
83501-6350 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1588610398
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
687GB |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1588610398
-
- CODING SYSTEM: VASTANUM
- ID: 687GB
-
- CODING SYSTEM: CLIA
- ID: 13D1078596
|
