Healthcare Provider Details

I. General information

NPI: 1992824635
Provider Name (Legal Business Name): MICHAEL E. DEBACKEY VETERANS AFFAIRS MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 HOLCOMBE BLVD
HOUSTON TX
77030-4211
US

IV. Provider business mailing address

8300 EL MUNDO ST APT. # 704
HOUSTON TX
77054-4681
US

V. Phone/Fax

Practice location:
  • Phone: 713-791-1414
  • Fax:
Mailing address:
  • Phone: 210-393-4862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number370126
License Number StateTX

VIII. Authorized Official

Name: MRS. NICOLE DAWN WIEMERS
Title or Position: RADIATION THERAPIST
Credential: BSRTT
Phone: 713-791-1414