Provider Demographics
NPI:1043435357
Name:MICHAEL E. DEBAKEY VA MEDICAL CENTER
Entity Type:Organization
Organization Name:MICHAEL E. DEBAKEY VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOLOGICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:GAJDUSEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:18307 FERNBLUFF DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-4034
Mailing Address - Country:US
Mailing Address - Phone:832-298-3338
Mailing Address - Fax:
Practice Address - Street 1:18307 FERNBLUFF DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-4034
Practice Address - Country:US
Practice Address - Phone:832-298-3338
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital