Provider Demographics
NPI:1124206503
Name:LEXINGTON MOREHEAD CBOC
Entity Type:Organization
Organization Name:LEXINGTON MOREHEAD CBOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-254-0385
Mailing Address - Street 1:1101 61ST STREET
Mailing Address - Street 2:
Mailing Address - City:GALVESTON ISLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77551
Mailing Address - Country:US
Mailing Address - Phone:409-740-3329
Mailing Address - Fax:
Practice Address - Street 1:1101 61ST STREET
Practice Address - Street 2:
Practice Address - City:GALVESTON ISLAND
Practice Address - State:TX
Practice Address - Zip Code:77551
Practice Address - Country:US
Practice Address - Phone:409-740-3329
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOUSTON VAMC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA