| NAME |
WYTHEVILLE VA CLINIC |
| STATE |
VIRGINIA |
| STREET ADDR. 1 |
165 PEPPERS FERRY ROAD |
| CITY |
WYTHEVILLE |
| ZIP |
24382-2363 |
| OFFICIAL VA NAME |
WYTHEVILLE VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
WYTHEVILLE VA CLINIC |
| ST. ADDR. 1 (MAILING) |
165 PEPPERS FERRY ROAD |
| CITY (MAILING) |
WYTHEVILLE |
| STATE (MAILING) |
VIRGINIA |
| ZIP (MAILING) |
24382-2363 |
| EFFECTIVE DATE/TIME |
-
- 2011-03-01 00:00:00
- STATUS: ACTIVE
- NPI: 1154626125
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
EASTERN |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
658GE |
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 49D2021266
|
