LAKE JACKSON CBOC (3653) INSTITUTION (4)

Name	Value
NAME	LAKE JACKSON CBOC
STATE	TEXAS
STREET ADDR. 1	208 S. OAK DRIVE SUITE 700
CITY	LAKE JACKSON
ZIP	77566-5790
OFFICIAL VA NAME	LAKE JACKSON CBOC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 16 PARENT FACILITY PARENT OF ASSOCIATION: HOUSTON VAMC
BILLING FACILITY NAME	LAKE JACKSON VA CBOC
EFFECTIVE DATE/TIME	2011-08-29 00:00:00 STATUS: ACTIVE NPI: 1902186000
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	580GF
IDENTIFIER	CODING SYSTEM: CLIA ID: 45D2037946