Provider Demographics
NPI:1467897041
Name:VA HEARTLAND-EAST, VISN 15
Entity Type:Organization
Organization Name:VA HEARTLAND-EAST, VISN 15
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PING
Authorized Official - Middle Name:
Authorized Official - Last Name:HOU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-652-4100
Mailing Address - Street 1:1 JEFFERSON BARRACKS DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63125-4181
Mailing Address - Country:US
Mailing Address - Phone:314-652-4100
Mailing Address - Fax:
Practice Address - Street 1:915 N GRAND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63106-1621
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011028709275N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes275N00000XHospital UnitsMedicare Defined Swing Bed Unit