Provider Demographics
NPI:1477640803
Name:HOUSTONVAMC
Entity Type:Organization
Organization Name:HOUSTONVAMC
Other - Org Name:VAMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIAGNOSTIC ANALYST
Authorized Official - Prefix:MR
Authorized Official - First Name:BOYZIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:OTHER
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:12922 REGG DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77045-3218
Mailing Address - Country:US
Mailing Address - Phone:713-723-9401
Mailing Address - Fax:713-794-7985
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:713-794-7985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========OtherDIAGNOSTIC