Provider Demographics
NPI:1093816472
Name:MICHAEL E. DEBAKEY VA HOSPITAL
Entity Type:Organization
Organization Name:MICHAEL E. DEBAKEY VA HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:4038 TEAL RUN PLACE COURT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545
Mailing Address - Country:US
Mailing Address - Phone:281-431-5827
Mailing Address - Fax:
Practice Address - Street 1:4038 TEAL RUN PLACE COURT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545
Practice Address - Country:US
Practice Address - Phone:281-431-5827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital