JACKIE WALORSKI VA CLINIC (3750) INSTITUTION (4)

Name	Value
NAME	JACKIE WALORSKI VA CLINIC
STATE	INDIANA
STREET ADDR. 1	1540 TRINITY PLACE
CITY	MISHAWAKA
ZIP	46545-5006
OFFICIAL VA NAME	JACKIE WALORSKI VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 10 PARENT FACILITY PARENT OF ASSOCIATION: MARION VA MEDICAL CENTER
BILLING FACILITY NAME	MISHAWAKA VA CLINIC
EFFECTIVE DATE/TIME	2016-09-18 00:00:00 STATUS: ACTIVE NPI: 1427597707
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	610BY
IDENTIFIER	CODING SYSTEM: CLIA ID: 15D2133739