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General NPI Number Information
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NPI Number | 1659758464
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF VETERAN AFFAIRS
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Dates
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Enumeration Date | 04/30/2015
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Last Update Date | 04/30/2015
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Provider Practice Location Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-1984
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Fax |
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Provider Business Mailing Address
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Address Line | 4500 S LANCASTER RD
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City | DALLAS
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State | TX
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Zip | 75216-7167
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Country | US
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Telephone | 214-857-1984
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Fax |
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Authorized Official
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Title or Position | CHIEF
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Name | MRS. KIM FITE-THURSTON
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Credential | LCSW
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Telephone | 214-857-0380
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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 | 60351
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License Number State | TX
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