MEDICARE: 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	284300000X	Special Hospital	247200000X	TX

General Provider Information

NPI Number	:	1619292794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VA HOSPITAL

Provider Business Mailing Address
First Line	:	7329 FANNIN
Second Line	:	VA DOMICILIARY
City	:	HOUSTON
State	:	TX
Zip	:	77030
Country	:	US
Telephone Number	:	713-791-1414
Fax Number	:

Provider Business Practice Location Address
First Line	:	7329 FANNIN ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-4805
Country	:	US
Telephone Number	:	713-791-1414
Fax Number	:

Authorized Official
Title or Position	:	DOMICILIARY
Name	:	MRS. MARY LOU HEATER
Credential	:	RN, CNS
Telephone Number	:	713-794-1414

Provider Enumeration Date	:	04/01/2010
Last Update Date	:	04/01/2010

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Directions to “VA HOSPITAL ” Practice Location

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