| NAME |
BAD AXE VA CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
1142 S VAN DYKE RD |
| CITY |
BAD AXE |
| ZIP |
48413-9800 |
| OFFICIAL VA NAME |
BAD AXE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BAD AXE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2010-08-11 00:00:00
- STATUS: ACTIVE
- NPI: 1588979801
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
655GF |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 1142 S. VAN DYKE RD
- CITY (CHANGED FROM): BAD AXE
- STATE (CHANGED FROM): MICHIGAN
- ZIP (CHANGED FROM): 48413-9800
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 23D2017037
|
