Provider Demographics
NPI:1194948430
Name:VA DEPARTMENT OF VETERANS AFFAIRS
Entity type:Organization
Organization Name:VA DEPARTMENT OF VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RADIOGRAPHER TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:DUONG
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:RT
Authorized Official - Phone:713-517-3746
Mailing Address - Street 1:10339 CLAY BROOK DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77089-2164
Mailing Address - Country:US
Mailing Address - Phone:713-517-3746
Mailing Address - Fax:
Practice Address - Street 1:10339 CLAY BROOK DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-2164
Practice Address - Country:US
Practice Address - Phone:713-517-3746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital