Segment: NM1
Loop: 2420C Segment: NM1
Element: NM101 (Service Facility Location Entity Identifier Code)
Hard coded to '77'.
Element: NM102 (Service Facility Location Entity Type Qualifier)
Hard coded to '2'.
Element: NM103 (Service Facility Name)
Facility Manager->Edit Facility->Full Legal Name
Element: NM108 (Service Facility Location Identification Code Qualifier)
Hard coded to 'XX'.
Element: NM109 (Service Facility Location NPI)
Facility Manager->Edit Facility->NPI