LA GRANDE CBOC (4062) INSTITUTION (4)

Name	Value
NAME	LA GRANDE CBOC
STATE	OREGON
STREET ADDR. 1	202 12TH STREET
CITY	LA GRANDE
ZIP	97850-2879
OFFICIAL VA NAME	LA GRANDE CBOC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 20 PARENT FACILITY PARENT OF ASSOCIATION: JONATHAN M. WAINWRIGHT VAMC
BILLING FACILITY NAME	LA GRANDE VA CLINIC
EFFECTIVE DATE/TIME	2008-01-31 00:00:00 STATUS: ACTIVE NPI: 1184812943
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	PACIFIC
COUNTRY	USA
STATION NUMBER	687GC
IDENTIFIER	CODING SYSTEM: CLIA ID: 38D1083646