OCONOMOWOC VA CLINIC (4668) INSTITUTION (4)

Name	Value
NAME	OCONOMOWOC VA CLINIC
STATE	WISCONSIN
STREET ADDR. 1	1289 OLYMPIA FIELDS DR
CITY	OCONOMOWOC
ZIP	53066-1277
OFFICIAL VA NAME	OCONOMOWOC VA CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 12 PARENT FACILITY PARENT OF ASSOCIATION: MILWAUKEE VAMC
BILLING FACILITY NAME	OCONOMOWOC VA CLINIC
EFFECTIVE DATE/TIME	2024-01-16 00:00:00 STATUS: ACTIVE NPI: 1932960945
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	695GE
HISTORY
IDENTIFIER	CODING SYSTEM: CLIA ID: 52D2293805