PUEBLO VA CLINIC (2092) INSTITUTION (4)

Name	Value
NAME	PUEBLO VA CLINIC
STATE	COLORADO
STREET ADDR. 1	4776 EAGLERIDGE CIRCLE
CITY	PUEBLO
ZIP	81008-2189
OFFICIAL VA NAME	PFC JAMES DUNN VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 19 PARENT FACILITY PARENT OF ASSOCIATION: ROCKY MOUNTAIN REGIONAL VAMC
BILLING FACILITY NAME	PUEBLO VA CLINIC
ST. ADDR. 1 (MAILING)	4776 EAGLERIDGE CIRCLE
CITY (MAILING)	PUEBLO
STATE (MAILING)	COLORADO
ZIP (MAILING)	81008-2189
EFFECTIVE DATE/TIME	2007-01-08 00:00:00 STATUS: ACTIVE NPI: 1205874526
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	MOUNTAIN
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	554GD
HISTORY	EFFECTIVE DATE: 2001-10-01 00:00:00 REALIGNED FROM: ZZ PUEBLO CBOC
IDENTIFIER	CODING SYSTEM: NPI ID: 1205874526 CODING SYSTEM: VASTANUM ID: 554GD CODING SYSTEM: CLIA ID: 06D0987874