| NAME |
BLACKWELL CBOC |
| STATE |
OKLAHOMA |
| STREET ADDR. 1 |
1009 W. FERGUSON AVE |
| STREET ADDR. 2 |
BLACKWELL FAMILY MEDICINE |
| CITY |
BLACKWELL |
| ZIP |
74631-5602 |
| OFFICIAL VA NAME |
BLACKWELL CBOC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
BLACKWELL VA CBOC |
| ST. ADDR. 1 (MAILING) |
1009 W. FERGUSON AVE |
| ST. ADDR. 2 (MAILING) |
BLACKWELL FAMILY MEDICINE |
| CITY (MAILING) |
BLACKWELL |
| STATE (MAILING) |
OKLAHOMA |
| ZIP (MAILING) |
74631-5602 |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1639118060
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
635GC |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1639118060
-
- CODING SYSTEM: VASTANUM
- ID: 635GC
|
