LAKESIDE CBOC (2200)    INSTITUTION (4)

Name Value
NAME LAKESIDE CBOC
STATE ILLINOIS
STREET ADDR. 1 211 E ONTARIO ST STE 1200
CITY CHICAGO
ZIP 60611-3276
OFFICIAL VA NAME LAKESIDE CBOC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME CHICAGO VA CLINIC
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1639126535
TAXONOMY CODE
LOCATION TIMEZONE CENTRAL
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 537GD
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1639126535
  • CODING SYSTEM:   VASTANUM
    ID:   537GD