Provider Demographics
NPI:1992824635
Name:MICHAEL E. DEBACKEY VETERANS AFFAIRS MEDICAL CENTER
Entity Type:Organization
Organization Name:MICHAEL E. DEBACKEY VETERANS AFFAIRS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIATION THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:WIEMERS
Authorized Official - Suffix:
Authorized Official - Credentials:BSRTT
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:8300 EL MUNDO ST
Mailing Address - Street 2:APT. # 704
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-4681
Mailing Address - Country:US
Mailing Address - Phone:210-393-4862
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:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX370126286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital