Provider Demographics
NPI:1235248287
Name:SOUTH TEXAS VETERANS HEALTH CARE SYSTEMS
Entity Type:Organization
Organization Name:SOUTH TEXAS VETERANS HEALTH CARE SYSTEMS
Other - Org Name:AUDIE L. MURPHY HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:KIZZIE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:210-617-5300
Mailing Address - Street 1:7400 MERTON MINTER ST
Mailing Address - Street 2:112B
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4404
Mailing Address - Country:US
Mailing Address - Phone:210-617-5300
Mailing Address - Fax:210-617-5300
Practice Address - Street 1:7400 MERTON MINTER ST
Practice Address - Street 2:112B
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4404
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:210-617-5300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03282286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital