KENOSHA CBOC (2169)    INSTITUTION (4)

Name Value
NAME KENOSHA CBOC
STATE WISCONSIN
STREET ADDR. 1 8207 22ND AVENUE
CITY KENOSHA
ZIP 53143-6211
OFFICIAL VA NAME KENOSHA CBOC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME KENOSHA VA CBOC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1144276064
TAXONOMY CODE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 556GD
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1144276064
  • CODING SYSTEM:   VASTANUM
    ID:   556GD
  • CODING SYSTEM:   CLIA
    ID:   52D1024853