| Name | Value |
|---|---|
| PROVIDER TYPE | Group |
| CLASSIFICATION | Multi-Specialty |
| DEFINITION | A business group of one or more individual practitioners, who practice with different areas of specialization. |
| STATUS | Active |
| VA CODE | V183411 |
| X12 CODE | 193200000X |
| SPECIALTY CODE | 70 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252648 |
| EFFECTIVE DATE/TIME |
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