Provider Demographics
NPI:1629221411
Name:MICHAEL E.DEBAKEY VAMC
Entity Type:Organization
Organization Name:MICHAEL E.DEBAKEY VAMC
Other - Org Name:VA HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LIZET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCLAT
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN
Authorized Official - Phone:713-794-7781
Mailing Address - Street 1:8210 GLEN RILEY DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6501
Mailing Address - Country:US
Mailing Address - Phone:281-277-7203
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBLEBLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
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:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX611701261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA