CACHE VALLEY VA CLINIC (4489)    INSTITUTION (4)

Name Value
NAME CACHE VALLEY VA CLINIC
STATE UTAH
STREET ADDR. 1 2380 NORTH 400 EAST, STE G
CITY NORTH LOGAN
ZIP 84341-1769
OFFICIAL VA NAME CACHE VALLEY VA CLINIC
STATUS National
ASSOCIATIONS
BILLING FACILITY NAME NORTH LOGAN VA CLINIC
EFFECTIVE DATE/TIME
  • 2020-07-28 00:00:00
    STATUS:   ACTIVE
    NPI:   1659980316
TAXONOMY CODE
LOCATION TIMEZONE MOUNTAIN
COUNTRY USA
AGENCY CODE VA
POINTER TO AGENCY VA
STATION NUMBER 660QD
IDENTIFIER
  • CODING SYSTEM:   CLIA
    ID:   46D2182475