MEDICARE: MICHAEL E. DEBAKEY VA HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	283Q00000X	Psychiatric Hospital

General Provider Information

NPI Number	:	1093816472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL E. DEBAKEY VA HOSPITAL

Provider Business Mailing Address
First Line	:	4038 TEAL RUN PLACE COURT
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545
Country	:	US
Telephone Number	:	281-431-5827
Fax Number	:

Provider Business Practice Location Address
First Line	:	4038 TEAL RUN PLACE COURT
Second Line	:
City	:	FRESNO
State	:	TX
Zip	:	77545
Country	:	US
Telephone Number	:	281-431-5827
Fax Number	:

Authorized Official
Title or Position	:	HEALTH TECHNICIAN
Name	:	MR. MICHAEL RAY WILSON
Credential	:
Telephone Number	:	713-791-1414

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	08/22/2020

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