| NAME |
JACKSONVILLE NORTH VA CLINIC |
| STATE |
FLORIDA |
| STREET ADDR. 1 |
145 HERON BAY RD |
| CITY |
JACKSONVILLE |
| ZIP |
32218-3595 |
| OFFICIAL VA NAME |
JACKSONVILLE NORTH VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
JACKSONVILLE 2 VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2014-10-01 00:00:00
- STATUS: ACTIVE
- NPI: 1649678988
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
573QG |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 6900 SOUTHPOINT DRIVE, NORTH
- CITY (CHANGED FROM): JACKSONVILLE
- STATE (CHANGED FROM): FLORIDA
- ZIP (CHANGED FROM): 32216-8007
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 10D1106852
|
