Healthcare Provider Details

I. General information

NPI: 1184159725
Provider Name (Legal Business Name): VETERANS ADMINISTRATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2017
Last Update Date: 04/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 HORIZON HILL
SAN ANTONIO TX
78229
US

IV. Provider business mailing address

139 MANNING
SAN ANTONIO TX
78228-5926
US

V. Phone/Fax

Practice location:
  • Phone: 210-617-5300
  • Fax: 210-321-2720
Mailing address:
  • Phone: 210-617-5300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License Number10383
License Number StateTX

VIII. Authorized Official

Name: DR. JULIE FLYNN
Title or Position: VA HOSPITAL DIRECTOR
Credential:
Phone: 210-617-5300