| NAME |
BROADWAY VA CLINIC |
| STATE |
TEXAS |
| STREET ADDR. 1 |
7916 S BROADWAY AVE STE 100 |
| CITY |
TYLER |
| ZIP |
75703-5275 |
| OFFICIAL VA NAME |
BROADWAY VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
TYLER 1 VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2015-06-04 00:00:00
- STATUS: ACTIVE
- NPI: 1629459730
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
549QC |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 7916 S. BROADWAY AVE, #100
- CITY (CHANGED FROM): TYLER
- STATE (CHANGED FROM): TEXAS
- ZIP (CHANGED FROM): 75703-5275
|
