MT. VERNON IL CBOC (2021) INSTITUTION (4)

Name	Value
NAME	MT. VERNON IL CBOC
STATE	ILLINOIS
STREET ADDR. 1	4000 S WATER TOWER PL
CITY	MT. VERNON
ZIP	62864-9998
OFFICIAL VA NAME	MT. VERNON IL CBOC (657GK)
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 15 PARENT FACILITY PARENT OF ASSOCIATION: MARION IL VAMC
BILLING FACILITY NAME	MT. VERNON VA CLINIC
EFFECTIVE DATE/TIME	2007-01-08 00:00:00 STATUS: ACTIVE NPI: 1902840622
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	657GK
HISTORY	EFFECTIVE DATE: 2001-07-01 00:00:00 REALIGNED FROM: ZZ MT VERNON CBOC
IDENTIFIER	CODING SYSTEM: NPI ID: 1902840622 CODING SYSTEM: VASTANUM ID: 657GK