MOUNTAIN HOME VA CLINIC (3508) INSTITUTION (4)

Name	Value
NAME	MOUNTAIN HOME VA CLINIC
STATE	IDAHO
STREET ADDR. 1	815 NORTH 6TH EAST
CITY	MOUNTAIN HOME
ZIP	83647-2207
OFFICIAL VA NAME	MOUNTAIN HOME VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 20 PARENT FACILITY PARENT OF ASSOCIATION: BOISE VA MEDICAL CENTER
BILLING FACILITY NAME	MOUNTAIN HOME VA CLINIC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1003223165
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	MOUNTAIN
COUNTRY	USA
STATION NUMBER	531GI
IDENTIFIER	CODING SYSTEM: CLIA ID: 13D2021272