Provider Demographics
NPI:1811027972
Name:NORTH TEXAS VETERANS HOSPITAL ADMINISTRATION
Entity Type:Organization
Organization Name:NORTH TEXAS VETERANS HOSPITAL ADMINISTRATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE CASE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:LYNETTE
Authorized Official - Last Name:MANUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-882-6173
Mailing Address - Street 1:4000 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3415
Mailing Address - Country:US
Mailing Address - Phone:817-267-1666
Mailing Address - Fax:
Practice Address - Street 1:300 W ROSEDALE ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4856
Practice Address - Country:US
Practice Address - Phone:817-882-6173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QV0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QV0200XAmbulatory Health Care FacilitiesClinic/CenterVA