SOUTH JORDAN VA CLINIC (3968) INSTITUTION (4)

Name	Value
NAME	SOUTH JORDAN VA CLINIC
STATE	UTAH
STREET ADDR. 1	5119 WEST DAYBREAK PARKWAY
CITY	SOUTH JORDAN
ZIP	84009-9998
OFFICIAL VA NAME	SOUTH JORDAN VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 19 PARENT FACILITY PARENT OF ASSOCIATION: GEORGE E. WAHLEN VAMC
BILLING FACILITY NAME	SOUTH JORDAN VA CLINIC
EFFECTIVE DATE/TIME	2009-01-01 00:00:00 STATUS: ACTIVE NPI: 1619113115
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	MOUNTAIN
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	660GJ
IDENTIFIER	CODING SYSTEM: CLIA ID: 46D1094237