| NAME |
CORALVILLE VA CBOC |
| STATE |
IOWA |
| STREET ADDR. 1 |
2213 2ND ST |
| CITY |
CORALVILLE |
| ZIP |
52241-1205 |
| OFFICIAL VA NAME |
CORALVILLE VA CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
CORALVILLE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2014-10-01 00:00:00
- STATUS: ACTIVE
- NPI: 1558778514
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
636GW |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 520 10TH AVENUE, #100
- CITY (CHANGED FROM): CORALVILLE
- STATE (CHANGED FROM): IOWA
- ZIP (CHANGED FROM): 52241-1910
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 16D1039402
|
