Provider Demographics
NPI:1821205840
Name:HOSPITAL
Entity Type:Organization
Organization Name:HOSPITAL
Other - Org Name:VA MEDICAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:RN
Authorized Official - Prefix:MRS
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:VANESSA
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-742-8387
Mailing Address - Street 1:605 AUSTIN DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-6605
Mailing Address - Country:US
Mailing Address - Phone:972-230-0854
Mailing Address - Fax:
Practice Address - Street 1:605 AUSTIN DR
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-6605
Practice Address - Country:US
Practice Address - Phone:972-230-0854
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX581741282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital