Provider Demographics
NPI:1609978204
Name:VETERANS AFFAIRS HOSPITAL
Entity Type:Organization
Organization Name:VETERANS AFFAIRS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESPIRATORY
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:AMISTOSO
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:11802 WHITE WATER BAY DR
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-8778
Mailing Address - Country:US
Mailing Address - Phone:713-436-1253
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-03
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX647692865M2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital