=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851647903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHEAL E. DEBAKEY VA MEDICAL CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2012
-----------------------------------------------------
Last Update Date | 07/26/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14907 SUGAR CUP CT
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77498-4071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-495-3223
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2002 HOLCOMBE BLVD
-----------------------------------------------------
City | HOUSTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77030-4211
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE MANAGER
-----------------------------------------------------
Name | MS. VERONICA ROGERS
-----------------------------------------------------
Credential | RN, MSN
-----------------------------------------------------
Telephone | 713-791-1414
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 283Q00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 273R00000X
-----------------------------------------------------
Taxonomy Name | Psychiatric Hospital Unit
-----------------------------------------------------
License Number | 665703
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------