Healthcare Provider Details

I. General information

NPI: 1801346143
Provider Name (Legal Business Name): THOMAS E. CREEK VAHCS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2016
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6010 W AMARILLO BLVD
AMARILLO TX
79106-1990
US

IV. Provider business mailing address

6010 W AMARILLO BLVD
AMARILLO TX
79106-1990
US

V. Phone/Fax

Practice location:
  • Phone: 806-355-9703
  • Fax: 806-356-3783
Mailing address:
  • Phone: 806-355-9703
  • Fax: 806-356-3783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number53985
License Number StateTX

VIII. Authorized Official

Name: MS. DEBORAH HIATT
Title or Position: CHIEF CMSW
Credential: LCSW
Phone: 806-355-9703