| NAME |
BOWLING GREEN |
| STATE |
KENTUCKY |
| STREET ADDR. 1 |
600 US 31 WEST BYPASS, SUITE #12 |
| STREET ADDR. 2 |
HEARTLAND MEDICAL PLAZA |
| CITY |
BOWLING GREEN |
| ZIP |
42101-4905 |
| OFFICIAL VA NAME |
BOWLING GREEN COMMUNITY BASED OUTPATIENT CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BOWLING GREEN VA CLINIC |
| ST. ADDR. 1 (MAILING) |
1110 WILKINSON TRACE CIRCLE |
| ST. ADDR. 2 (MAILING) |
HEARTLAND MEDICAL PLAZA |
| CITY (MAILING) |
BOWLING GREEN |
| STATE (MAILING) |
KENTUCKY |
| ZIP (MAILING) |
42103-3402 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1639120215
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
626GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1639120215
-
- CODING SYSTEM: VASTANUM
- ID: 626GC
|
