WAYCROSS VA CLINIC (3630) INSTITUTION (4)

Name	Value
NAME	WAYCROSS VA CLINIC
STATE	GEORGIA
STREET ADDR. 1	515B CITY BOULEVARD
CITY	WAYCROSS
ZIP	31501-8016
OFFICIAL VA NAME	WAYCROSS VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 8 PARENT FACILITY PARENT OF ASSOCIATION: N. FLORIDA/S. GEORGIA HCS
BILLING FACILITY NAME	WAYCROSS VA CBOC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1407263452
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	EASTERN
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	573GM
IDENTIFIER	CODING SYSTEM: CLIA ID: 11D2009598