=====================================================
General NPI Number Information
=====================================================
NPI Number | 1033464425
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHEAL E DEBAKEY VA HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2012
-----------------------------------------------------
Last Update Date | 07/20/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 HOLCOMBE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
Fax | 713-794-7512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2002 HOLCOMBE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
Fax | 713-794-7512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | STAFF NURSE
-----------------------------------------------------
Name | MS. SHIRLEY A COLLINS
-----------------------------------------------------
Credential | RN, PMHN-BC
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 640793
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------