Provider Demographics
NPI:1124308275
Name:MICHAEL E DEBAKEY VAMC
Entity type:Organization
Organization Name:MICHAEL E DEBAKEY VAMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/STAFF NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:RN/MSN
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:4030 LONGWAY ESTATES CT
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-8645
Mailing Address - Country:US
Mailing Address - Phone:713-791-1414
Mailing Address - Fax:
Practice Address - Street 1:4030 LONGWAY ESTATES CT
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:TX
Practice Address - Zip Code:77545-8645
Practice Address - Country:US
Practice Address - Phone:713-791-1414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-22
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX680837283Q00000X, 2865M2000X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No283Q00000XHospitalsPsychiatric Hospital
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital