| NAME |
PFC. JUSTIN T. PATON VA CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
5739 HIGHWAY M-68 |
| CITY |
INDIAN RIVER |
| ZIP |
49749-9998 |
| OFFICIAL VA NAME |
PFC. JUSTIN T. PATON VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
INDIAN RIVER VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2011-09-01 00:00:00
- STATUS: ACTIVE
- NPI: 1326329962
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
655GH |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 14540 MACKINAW HWY
- CITY (CHANGED FROM): MACKINAW CITY
- STATE (CHANGED FROM): MICHIGAN
- ZIP (CHANGED FROM): 49701-9507
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 23D2026593
|
