| NAME |
UNION GROVE |
| STATE |
WISCONSIN |
| STREET ADDR. 1 |
21425 SPRING STREET |
| CITY |
UNION GROVE |
| ZIP |
53182-9707 |
| OFFICIAL VA NAME |
Union Grove |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
UNION GROVE VA CBOC |
| ST. ADDR. 1 (MAILING) |
21425 SPRING STREET |
| CITY (MAILING) |
UNION GROVE |
| STATE (MAILING) |
WISCONSIN |
| ZIP (MAILING) |
53182-9707 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1326087222
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
695GA |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1326087222
-
- CODING SYSTEM: VASTANUM
- ID: 695GA
-
- CODING SYSTEM: CLIA
- ID: 52D0999850
|
