| NAME |
LAKE OF THE OZARKS VA CLINIC |
| STATE |
MISSOURI |
| STREET ADDR. 1 |
30 LAKEVIEW CT |
| CITY |
CAMDENTON |
| ZIP |
65020-9998 |
| OFFICIAL VA NAME |
LAKE OF THE OZARKS VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
CAMDENTON VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1508808775
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
589GH |
| HISTORY |
-
- EFFECTIVE DATE: 2001-04-01 00:00:00
- REALIGNED FROM: ZZ LAKE OZARK CBOC
-
- STREET ADDR. 1 (CHANGED FROM): 940 EXECUTIVE DRIVE
- CITY (CHANGED FROM): OSAGE BEACH
- STATE (CHANGED FROM): MISSOURI
- ZIP (CHANGED FROM): 65065-3497
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1508808775
-
- CODING SYSTEM: VASTANUM
- ID: 589GH
-
- CODING SYSTEM: CLIA
- ID: 26D1028176
|
