| NAME |
LA JUNTA CBOC |
| STATE |
COLORADO |
| STREET ADDR. 1 |
1100 CARSON AVENUE, SUITE 204 |
| CITY |
LA JUNTA |
| ZIP |
81050-2751 |
| OFFICIAL VA NAME |
LA JUNTA COMMUNITY BASED OUTPATIENT CLINIC (554GG) |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
LA JUNTA VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1100 CARSON AVENUE, SUITE 204 |
| CITY (MAILING) |
LA JUNTA |
| STATE (MAILING) |
COLORADO |
| ZIP (MAILING) |
81050-2751 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1023065067
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
554GG |
| HISTORY |
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1023065067
-
- CODING SYSTEM: VASTANUM
- ID: 554GG
-
- CODING SYSTEM: CLIA
- ID: 06D1002390
|
