EVANSTON VA CLINIC (3993) INSTITUTION (4)

Name	Value
NAME	EVANSTON VA CLINIC
STATE	WYOMING
STREET ADDR. 1	1565 SOUTH HIGHWAY 150, #E
CITY	EVANSTON
ZIP	82930-5361
OFFICIAL VA NAME	EVANSTON VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 19 PARENT FACILITY PARENT OF ASSOCIATION: SHERIDAN VA MEDICAL CENTER
BILLING FACILITY NAME	EVANSTON VA CLINIC
EFFECTIVE DATE/TIME	2014-10-01 00:00:00 STATUS: ACTIVE NPI: 1043601255
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	MOUNTAIN
COUNTRY	USA
STATION NUMBER	666QB
IDENTIFIER	CODING SYSTEM: CLIA ID: 53D2012184