Healthcare Provider Details

I. General information

NPI: 1831291087
Provider Name (Legal Business Name): DALLAS VAMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 S LANCASTER RD 116
DALLAS TX
75216-7167
US

IV. Provider business mailing address

1211 HOLLY GLEN DR
DALLAS TX
75232
US

V. Phone/Fax

Practice location:
  • Phone: 214-857-0837
  • Fax:
Mailing address:
  • Phone: 214-371-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: ELSIE WITHERSPPOON
Title or Position: STAFF NURSE
Credential: R.N.
Phone: 214-857-0837