SHREVEPORT 1 VA MOBILE CLINIC (4636) INSTITUTION (4)

Name	Value
NAME	SHREVEPORT 1 VA MOBILE CLINIC
STATE	LOUISIANA
STREET ADDR. 1	510 E STONER AVE
CITY	SHREVEPORT
ZIP	71101-4243
OFFICIAL VA NAME	SHREVEPORT 1 VA MOBILE CLINIC
STATUS	National
ASSOCIATIONS	VISN PARENT OF ASSOCIATION: VISN 16 PARENT FACILITY PARENT OF ASSOCIATION: SHREVEPORT VAMC
BILLING FACILITY NAME	SHREVEPORT VA MOBILE CLINIC
EFFECTIVE DATE/TIME	2023-09-27 00:00:00 STATUS: ACTIVE NPI: 1679352942
TAXONOMY CODE	Ambulatory Health Care Facilities PRIMARY CODE: YES STATUS: ACTIVE
LOCATION TIMEZONE	CENTRAL
COUNTRY	USA
AGENCY CODE	VA
POINTER TO AGENCY	VA
STATION NUMBER	667QB
HISTORY