Provider Demographics
NPI:1710093893
Name:MEDVAMC
Entity Type:Organization
Organization Name:MEDVAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHARGE/STAFF NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAMONA
Authorized Official - Middle Name:RENITA
Authorized Official - Last Name:SMITH-CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN,C
Authorized Official - Phone:713-794-7559
Mailing Address - Street 1:5611 FORESTHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77066-2407
Mailing Address - Country:US
Mailing Address - Phone:281-537-6229
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:713-794-7559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596966282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital