JACKSON 2 VA MOBILE CLINIC (4586) INSTITUTION (4)

Name	Value
NAME	JACKSON 2 VA MOBILE CLINIC
STATE	MISSISSIPPI
STREET ADDR. 1	1500 E WOODROW WILSON AVE
CITY	JACKSON
ZIP	39216-5116
OFFICIAL VA NAME	JACKSON 2 VA MOBILE CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 16 PARENT FACILITY PARENT OF ASSOCIATION: JACKSON VAMC
BILLING FACILITY NAME	JACKSON 1 VA CLINIC
EFFECTIVE DATE/TIME	2022-06-16 00:00:00 STATUS: ACTIVE NPI: 1588393318
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	586QD
HISTORY