| Name | Value |
|---|---|
| PROVIDER TYPE | Other Service |
| CLASSIFICATION | Medical Record Administrator |
| STATUS | Inactive |
| DATE INACTIVATED | 1998-10-20 00:00:00 |
| VA CODE | V080800 |
| reserved | P652 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5253119 |
| EFFECTIVE DATE/TIME |
|