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General NPI Number Information
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NPI Number | 1992824635
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Entity Type | Organization
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Legal Business Name | MICHAEL E. DEBACKEY VETERANS AFFAIRS MEDICAL CENTER
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2002 HOLCOMBE BLVD
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City | HOUSTON
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State | TX
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Zip | 77030-4211
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Country | US
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Telephone | 713-791-1414
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 EL MUNDO ST APT. # 704
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City | HOUSTON
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State | TX
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Zip | 77054-4681
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Country | US
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Telephone | 210-393-4862
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Fax |
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Authorized Official
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Title or Position | RADIATION THERAPIST
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Name | MRS. NICOLE DAWN WIEMERS
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Credential | BSRTT
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Telephone | 713-791-1414
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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 | 370126
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License Number State | TX
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