FREEPORT CBOC (2207) INSTITUTION (4)

Name	Value
NAME	FREEPORT CBOC
STATE	ILLINOIS
STREET ADDR. 1	750 KIWANIS DRIVE, SUITE #250
CITY	FREEPORT
ZIP	61032-7119
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 12 PARENT FACILITY PARENT OF ASSOCIATION: WILLIAM S. MIDDLETON VAMC
BILLING FACILITY NAME	FREEPORT VA CLINIC
EFFECTIVE DATE/TIME	2007-03-26 00:00:00 STATUS: ACTIVE NPI: 1558414987
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
STATION NUMBER	607GF
IDENTIFIER	CODING SYSTEM: VASTANUM ID: 607GF CODING SYSTEM: CLIA ID: 14D1031462