| NAME |
CLARK COUNTY CBOC |
| STATE |
WISCONSIN |
| STREET ADDR. 1 |
8 JOHNSON STREET |
| CITY |
OWEN |
| ZIP |
54460-9534 |
| OFFICIAL VA NAME |
CLARK COUNTY CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
OWEN VA CBOC |
| ST. ADDR. 1 (MAILING) |
8 JOHNSON STREET |
| CITY (MAILING) |
OWEN |
| STATE (MAILING) |
WISCONSIN |
| ZIP (MAILING) |
54460-9534 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1902853567
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
676GE |
| HISTORY |
-
- EFFECTIVE DATE: 2001-10-15 00:00:00
- REALIGNED FROM: ZZ LOYAL ORC
|
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1902853567
-
- CODING SYSTEM: VASTANUM
- ID: 676GE
-
- CODING SYSTEM: CLIA
- ID: 52D2033515
|
