| NAME |
MARIANNA VA CLINIC |
| STATE |
FLORIDA |
| STREET ADDR. 1 |
4970 HIGHWAY 90 |
| CITY |
MARIANNA |
| ZIP |
32446-6802 |
| OFFICIAL VA NAME |
MARIANNA VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MARIANNA VA CBOC |
| ST. ADDR. 1 (MAILING) |
4970 HIGHWAY 90 |
| CITY (MAILING) |
MARIANNA |
| STATE (MAILING) |
FLORIDA |
| ZIP (MAILING) |
32446-6802 |
| EFFECTIVE DATE/TIME |
-
- 2008-04-11 00:00:00
- STATUS: ACTIVE
- NPI: 1255506911
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
573GK |
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 10D1085506
|
