=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285723262
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL E. DEBAKEY VETERANS AFFAIRS MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2002 HOLCOMBE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
Fax | 713-794-7377
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1 HERMANN MUSEUM CIRCLE DR 4042
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77004-7174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-527-0058
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL SOCIAL WORKER
-----------------------------------------------------
Name | MRS. ANDREA SUE CARTER
-----------------------------------------------------
Credential | LMSW
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282N00000X
-----------------------------------------------------
Taxonomy Name | General Acute Care Hospital
-----------------------------------------------------
License Number | 14040
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------