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General NPI Number Information
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NPI Number | 1487757969
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Entity Type | Organization
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Legal Business Name | V A HOSPITAL
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | FWOPC/ VA MEDICAL CENTER 300 W. ROSEDALE
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City | FORT WORTH
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State | TX
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Zip | 76104
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Country | US
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Telephone | 817-882-8185
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Fax |
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Provider Business Mailing Address
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Address Line | 220 PATRICIA LN
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City | HIGHLAND VILLAGE
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State | TX
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Zip | 75077-7176
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Country | US
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Telephone | 972-317-8919
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Fax |
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Authorized Official
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Title or Position | STAFF PHYSICIAN
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Name | DR. JASPAUL SINGH BHANGOO
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Credential | M.D.
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Telephone | 706-951-5778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23930
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License Number State | OK
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