Provider Demographics
NPI:1700895539
Name:AUDIE L MURPHY VETERANS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:AUDIE L MURPHY VETERANS MEMORIAL HOSPITAL
Other - Org Name:DEPT OF VETERANS HEALTH AFFAIRS
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-617-5104
Mailing Address - Street 1:7400 MERTON MINTER BLVD
Mailing Address - Street 2:DEPT. OF ORTHOPEDICS
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-617-5101
Mailing Address - Fax:210-617-5349
Practice Address - Street 1:7400 MERTON MINTER BLVD
Practice Address - Street 2:DEPT. OF ORTHOPEDICS
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-617-5101
Practice Address - Fax:210-617-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03012261QF0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85473VOtherBCBS PROVIDER NO.