PADUCAH KY CBOC (2022) INSTITUTION (4)

Name	Value
NAME	PADUCAH KY CBOC
STATE	KENTUCKY
STREET ADDR. 1	2620 PERKINS CREEL DRIVE
CITY	PADUCAH
ZIP	42001-7494
OFFICIAL VA NAME	PADUCAH KY CBOC (657GL)
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 15 PARENT FACILITY PARENT OF ASSOCIATION: MARION IL VAMC
BILLING FACILITY NAME	PADUCAH VA CLINIC
ST. ADDR. 1 (MAILING)	2620 PERKINS CREEL DRIVE
CITY (MAILING)	PADUCAH
STATE (MAILING)	KENTUCKY
ZIP (MAILING)	42001-7494
EFFECTIVE DATE/TIME	2007-01-08 00:00:00 STATUS: ACTIVE NPI: 1356384747
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	657GL
HISTORY	EFFECTIVE DATE: 2001-07-01 00:00:00 REALIGNED FROM: ZZ PADUCAH CBOC
IDENTIFIER	CODING SYSTEM: NPI ID: 1356384747 CODING SYSTEM: VASTANUM ID: 657GL