| NAME |
FORT JOHNSON VA CLINIC |
| STATE |
LOUISIANA |
| STREET ADDR. 1 |
3353 UNIVERSITY PKWY |
| CITY |
LEESVILLE |
| ZIP |
71446-9041 |
| OFFICIAL VA NAME |
FORT JOHNSON VA CLINIC |
| STATUS |
National |
| ASSOCIATIONS |
|
| BILLING FACILITY NAME |
LEESVILLE VA CLINIC |
| EFFECTIVE DATE/TIME |
-
- 2011-08-15 00:00:00
- STATUS: ACTIVE
- NPI: 1245513506
|
| TAXONOMY CODE |
|
| LOCATION TIMEZONE |
CENTRAL |
| COUNTRY |
USA |
| AGENCY CODE |
VA |
| POINTER TO AGENCY |
VA |
| STATION NUMBER |
502GF |
| HISTORY |
-
- STREET ADDR. 1 (CHANGED FROM): 3353 UNIVERSITY PARKWAY
- CITY (CHANGED FROM): LEESVILLE
- STATE (CHANGED FROM): LOUISIANA
- ZIP (CHANGED FROM): 71446-9041
|
| IDENTIFIER |
-
- CODING SYSTEM: CLIA
- ID: 19D2031062
|
