Provider Demographics
NPI:1235240375
Name:MICHAEL E. DEBAKEY VAMC - HOUSTON
Entity Type:Organization
Organization Name:MICHAEL E. DEBAKEY VAMC - HOUSTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL TECHNOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:PHUONG
Authorized Official - Last Name:NONG
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL TECHNOLOGIST
Authorized Official - Phone:713-794-7335
Mailing Address - Street 1:3352 BEACON VIEW CT
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7932
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3352 BEACON VIEW CT
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7932
Practice Address - Country:US
Practice Address - Phone:713-794-7335
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXASCP291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory