| NAME |
WILLIAMSPORT VA CLINIC |
| STATE |
PENNSYLVANIA |
| STREET ADDR. 1 |
1705 WARREN AVE 3RD FLOOR |
| CITY |
WILLIAMSPORT |
| ZIP |
17701-2647 |
| OFFICIAL VA NAME |
WILLIAMSPORT VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
WILLIAMSPORT VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1705 WARREN AVE 3RD FLOOR |
| CITY (MAILING) |
WILLIAMSPORT |
| STATE (MAILING) |
PENNSYLVANIA |
| ZIP (MAILING) |
17701-2647 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1750321527
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
693GB |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1750321527
-
- CODING SYSTEM: VASTANUM
- ID: 693GB
-
- CODING SYSTEM: CLIA
- ID: 39D1038003
|
