MEDICARE: HOUSTON VA HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	273R00000X	Psychiatric Hospital Unit	224351	TX

General Provider Information

NPI Number	:	1235240011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOUSTON VA HOSPITAL

Provider Business Mailing Address
First Line	:	807 KENFOREST DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2205
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	807 KENFOREST DR
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-2205
Country	:	US
Telephone Number	:	713-791-1414
Fax Number	:

Authorized Official
Title or Position	:	R.N.
Name	:	MRS. JOYCE LEE OMIDEYI
Credential	:
Telephone Number	:	713-791-1414

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	08/22/2020

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Directions to “HOUSTON VA HOSPITAL ” Practice Location

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