FORT WAYNE VA MEDICAL CENTER (240)    INSTITUTION (4)

Name Value
NAME FORT WAYNE VA MEDICAL CENTER
STATE INDIANA
STREET ADDR. 1 2121 LAKE AVE.
CITY FORT WAYNE
ZIP 46805-5100
OFFICIAL VA NAME FORT WAYNE VA MEDICAL CENTER
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME FORT WAYNE VAMC
ST. ADDR. 1 (MAILING) 2121 LAKE AVE
CITY (MAILING) FORT WAYNE
STATE (MAILING) INDIANA
ZIP (MAILING) 46805-5100
EFFECTIVE DATE/TIME
  • 2007-01-08 00:00:00
    STATUS:   ACTIVE
    NPI:   1568411791
TAXONOMY CODE
  • Hospitals
    PRIMARY CODE:   YES
    STATUS:   ACTIVE
LOCATION TIMEZONE EASTERN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 610A4
HISTORY
IDENTIFIER
  • CODING SYSTEM:   NPI
    ID:   1568411791
  • CODING SYSTEM:   VASTANUM
    ID:   610A4
  • CODING SYSTEM:   CLIA
    ID:   15D0988541