| NAME |
CALDWELL VA CLINIC |
| STATE |
IDAHO |
| STREET ADDR. 1 |
713 HAYSTACK WAY |
| CITY |
CALDWELL |
| ZIP |
83605-6981 |
| OFFICIAL VA NAME |
CALDWELL VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
CALDWELL VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-08-07 00:00:00
- STATUS: ACTIVE
- NPI: 1124152921
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
531GG |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 4521 THOMAS JEFFERSON ST
- CITY (CHANGED FROM): CALDWELL
- STATE (CHANGED FROM): IDAHO
- ZIP (CHANGED FROM): 83605-5100
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 13D1065097
|
