EAGLE SQUARE VA CLINIC (3909) INSTITUTION (4)

Name	Value
NAME	EAGLE SQUARE VA CLINIC
STATE	RHODE ISLAND
STREET ADDR. 1	623 ATWELLS AVE
CITY	PROVIDENCE
ZIP	02909-7403
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 1 PARENT FACILITY PARENT OF ASSOCIATION: PROVIDENCE VAMC
BILLING FACILITY NAME	EAGLE SQUARE VA OOS
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1679971311
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	EASTERN
COUNTRY	USA
STATION NUMBER	650QA