JACKSONVILLE 4 VA CLINIC (4436) INSTITUTION (4)

Name	Value
NAME	JACKSONVILLE 4 VA CLINIC
STATE	NORTH CAROLINA
STREET ADDR. 1	2580 HENDERSON DRIVE
CITY	JACKSONVILLE
ZIP	28546-5252
OFFICIAL VA NAME	JACKSONVILLE 4 VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 6 PARENT FACILITY PARENT OF ASSOCIATION: FAYETTEVILLE NC VAMC
BILLING FACILITY NAME	JACKSONVILLE 3 VA CLINIC
EFFECTIVE DATE/TIME	2020-01-15 00:00:00 STATUS: ACTIVE NPI: 1538799002
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	EASTERN
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	565GN
IDENTIFIER	CODING SYSTEM: CLIA ID: 34D2190079