IDAHO FALLS VA CLINIC (3970) INSTITUTION (4)

Name	Value
NAME	IDAHO FALLS VA CLINIC
STATE	IDAHO
STREET ADDR. 1	640 SOUTH WOODRUFF AVENUE
CITY	IDAHO FALLS
ZIP	83401-5299
OFFICIAL VA NAME	IDAHO FALLS VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 19 PARENT FACILITY PARENT OF ASSOCIATION: GEORGE E. WAHLEN VAMC
BILLING FACILITY NAME	IDAHO FALLS VA CLINIC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1497146823
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	660QA
IDENTIFIER	CODING SYSTEM: CLIA ID: 13D2091814