| NAME |
POLK STREET VA CLINIC |
| STATE |
TEXAS |
| STREET ADDR. 1 |
4243 S POLK ST |
| CITY |
DALLAS |
| ZIP |
75224-4928 |
| OFFICIAL VA NAME |
POLK STREET VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
DALLAS VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2014-10-01 00:00:00
- STATUS: ACTIVE
- NPI: 1215344254
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
549GK |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 4243 SOUTH POLK ST
- CITY (CHANGED FROM): DALLAS
- STATE (CHANGED FROM): TEXAS
- ZIP (CHANGED FROM): 75224-4928
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 45D2019607
|
