| NAME |
LYLE C PEARSON CBOC |
| STATE |
MINNESOTA |
| STREET ADDR. 1 |
1400 MADISON AVE STE 502 |
| CITY |
MANKATO |
| ZIP |
56001-5473 |
| OFFICIAL VA NAME |
LYLE C PEARSON CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
MANKATO VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2015-08-27 00:00:00
- STATUS: ACTIVE
- NPI: 1639615149
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
618GN |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1961 PREMIER DRIVE
- CITY (CHANGED FROM): MANKATO
- STATE (CHANGED FROM): MINNESOTA
- ZIP (CHANGED FROM): 56001-6492
|
