| NAME |
DECATUR VA CLINIC |
| STATE |
ILLINOIS |
| STREET ADDR. 1 |
792 NORTH SUNNYSIDE ROAD |
| CITY |
DECATUR |
| ZIP |
62522-1156 |
| OFFICIAL VA NAME |
DECATUR VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
DECATUR VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2007-01-08 00:00:00
- STATUS: ACTIVE
- NPI: 1124071881
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
550GA |
| IDENTIFIER |
-
- CODING SYSTEM: NPI
- ID: 1124071881
-
- CODING SYSTEM: VASTANUM
- ID: 550GA
-
- CODING SYSTEM: CLIA
- ID: 14D0988267
|
