Provider Demographics
NPI:1184038507
Name:VISN 17 CENTER OF EXCELLENCE FOR RESEARCH ON RETURNING WAR VETERANS
Entity Type:Organization
Organization Name:VISN 17 CENTER OF EXCELLENCE FOR RESEARCH ON RETURNING WAR VETERANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISORY HEALTH SYSTEM SPECIALIS
Authorized Official - Prefix:MS
Authorized Official - First Name:TANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-743-1133
Mailing Address - Street 1:701 WHISPERING OAKS DR
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-4930
Mailing Address - Country:US
Mailing Address - Phone:917-208-1071
Mailing Address - Fax:
Practice Address - Street 1:4800 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:151-C
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711
Practice Address - Country:US
Practice Address - Phone:917-208-1071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS01444283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital