Healthcare Provider Details

I. General information

NPI: 1114910882
Provider Name (Legal Business Name): VETERANS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6902 AMARILLO BLVD. WEST
AMARILLO TX
79124
US

IV. Provider business mailing address

6605 DIAMOND CT
AMARILLO TX
79124-1319
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-9703
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number33373
License Number StateTX

VIII. Authorized Official

Name: JOHN LAING
Title or Position: PHARMACIST
Credential:
Phone: 806-355-9703