| NAME |
PHOENIX VA CLINIC |
| STATE |
ARIZONA |
| STREET ADDR. 1 |
1500 E THOMAS RD STE 106 |
| CITY |
PHOENIX |
| ZIP |
85014-5748 |
| OFFICIAL VA NAME |
PHOENIX VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
PHOENIX VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2015-05-26 00:00:00
- STATUS: ACTIVE
- NPI: 1619352077
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
MOUNTAIN |
| COUNTRY |
USA |
| TIMEZONE EXCEPTION |
SST Only |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
644QA |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1500 EAST THOMAS RD, #106
- CITY (CHANGED FROM): PHOENIX
- STATE (CHANGED FROM): ARIZONA
- ZIP (CHANGED FROM): 85014-5748
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 03D2066724
|
