| NAME |
FORT MOORE VA CLINIC |
| STATE |
GEORGIA |
| STREET ADDR. 1 |
6635 BASS RD BLDG 9214 |
| CITY |
FORT BENNING |
| ZIP |
31905-5602 |
| OFFICIAL VA NAME |
FORT MOORE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
FORT BENNING VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2015-07-06 00:00:00
- STATUS: ACTIVE
- NPI: 1982074720
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
619QB |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 6635 BASS ROAD, BLDG 9214
- CITY (CHANGED FROM): FORT BENNING
- STATE (CHANGED FROM): GEORGIA
- ZIP (CHANGED FROM): 31905-9998
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 11D2104458
|
