BOB MICHEL VA OPC (216)    INSTITUTION (4)

Name Value
NAME BOB MICHEL VA OPC
STATE ILLINOIS
STREET ADDR. 1 7717 NORTH ORANGE PRAIRIE RD
CITY PEORIA
ZIP 61615-9323
OFFICIAL VA NAME BOB MICHEL VA OPC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME PEORIA VA CBOC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1134163736
TAXONOMY CODE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 550BY
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1134163736
  • CODING SYSTEM:   VASTANUM
    ID:   550BY
  • CODING SYSTEM:   CLIA
    ID:   14D0988265