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General NPI Number Information
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NPI Number | 1528240074
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Entity Type | Organization
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Legal Business Name | MEDVAMC-HOUSTON
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Dates
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Enumeration Date | 11/27/2007
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Last Update Date | 11/27/2007
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Provider Practice Location Address
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Address Line | 17307 DANBURY BRIDGE DR.
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City | HOUSTON
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State | TX
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Zip | 77095
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Country | US
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Telephone | 936-522-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2002 HOLCOME BLVD.
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City | HOUSTON
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State | TX
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Zip | 77030
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | STAFF NURSE
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Name | MS. CAROL ANN BECKWITH
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Credential | R.N.
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Telephone | 936-522-4000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 253803
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License Number State | TX
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