| NAME |
ZZ-GRAND TRAVERSE VA CLINIC |
| STATE |
MICHIGAN |
| STREET ADDR. 1 |
880 MUNSON AVENUE |
| CITY |
TRAVERSE CITY |
| ZIP |
49686-3661 |
| OFFICIAL VA NAME |
GRAND TRAVERSE VA CLINIC |
| INACTIVE FACILITY FLAG |
INACTIVE |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
TRAVERSE CITY VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2016-02-23 00:00:00
- STATUS: ACTIVE
- NPI: 1538520028
-
- 2020-03-17 00:00:00
- STATUS: INACTIVE
- NPI: 1538520028
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
655QB |
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 23D2109357
|
