BLOOMINGTON VA CLINIC (550GG) (4426) INSTITUTION (4)

Name	Value
NAME	BLOOMINGTON VA CLINIC (550GG)
STATE	ILLINOIS
STREET ADDR. 1	207 HAMILTON ROAD
CITY	BLOOMINGTON
ZIP	61704-7527
OFFICIAL VA NAME	BLOOMINGTON VA CLINIC (550GG)
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 12 PARENT FACILITY PARENT OF ASSOCIATION: ILLIANA HCS
BILLING FACILITY NAME	BLOOMINGTON VA CLINIC
EFFECTIVE DATE/TIME	2019-09-19 00:00:00 STATUS: ACTIVE NPI: 1609426709
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	550GG
IDENTIFIER	CODING SYSTEM: CLIA ID: 14D2173863