Healthcare Provider Details

I. General information

NPI: 1417239377
Provider Name (Legal Business Name): AUDIE MURPHY VA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 MERTON MINTER ST
SAN ANTONIO TX
78229-4404
US

IV. Provider business mailing address

11619 KRISTIDAWN
SAN ANTONIO TX
78253-5857
US

V. Phone/Fax

Practice location:
  • Phone: 210-957-1852
  • Fax:
Mailing address:
  • Phone: 210-957-1852
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOHN V VILLARTAZA JR.
Title or Position: RESPIRATORY THERAPIST
Credential: MEDICAL SERVICE
Phone: 210-617-5300