FORT INDIANTOWN GAP VA CLINIC (3719) INSTITUTION (4)

Name	Value
NAME	FORT INDIANTOWN GAP VA CLINIC
STATE	PENNSYLVANIA
STREET ADDR. 1	1 GARRISON RD, BLDG 4-114
STREET ADDR. 2	FORT INDIANTOWN GAP
CITY	ANNVILLE
ZIP	17003-5061
OFFICIAL VA NAME	FORT INDIANTOWN GAP VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 4 PARENT FACILITY PARENT OF ASSOCIATION: LEBANON VA MEDICAL CENTER
BILLING FACILITY NAME	FORT INDIANTOWN GAP VA CLINIC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1184012684
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	EASTERN
COUNTRY	USA
STATION NUMBER	595QA