Healthcare Provider Details

I. General information

NPI: 1275645954
Provider Name (Legal Business Name): DEPARTMENT OF VETERAN AFFAIRS VA NORTH TEXAS HEALTH CARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4638 TRAVIS ST APT 213
DALLAS TX
75205-4048
US

IV. Provider business mailing address

4638 TRAVIS ST APT 213
DALLAS TX
75205-4048
US

V. Phone/Fax

Practice location:
  • Phone: 314-857-0914
  • Fax:
Mailing address:
  • Phone: 214-857-0914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number16134
License Number StateTX

VIII. Authorized Official

Name: SCOTT LIND
Title or Position: SWA
Credential:
Phone: 214-857-0914