| Name | Value |
|---|---|
| PROVIDER TYPE | Hospitals |
| CLASSIFICATION | Military Hospital |
| AREA OF SPECIALIZATION | Community Health |
| STATUS | Inactive |
| DATE INACTIVATED | 2005-04-01 00:00:00 |
| X12 CODE | 2865C1500X |
| INDIVIDUAL/NON | NON-INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252711 |
| EFFECTIVE DATE/TIME |
|