EAGLE STREET VA CLINIC (4484) INSTITUTION (4)

Name	Value
NAME	EAGLE STREET VA CLINIC
STATE	RHODE ISLAND
STREET ADDR. 1	75 EAGLE STREET
CITY	PROVIDENCE
ZIP	02909-1081
OFFICIAL VA NAME	EAGLE STREET VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 1 PARENT FACILITY PARENT OF ASSOCIATION: PROVIDENCE VAMC
BILLING FACILITY NAME	PROVIDENCE VA CLINIC
EFFECTIVE DATE/TIME	2017-11-30 00:00:00 STATUS: ACTIVE NPI: 1710461215
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	650QB