1477588820 NPI number — CENTRAL TEXAS VETERAN'S HEALTH CARE SYSTEM

Table of content: (NPI 1477588820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477588820 NPI number — CENTRAL TEXAS VETERAN'S HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS VETERAN'S HEALTH CARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TEMPLE VA HOSPITAL
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477588820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 ESTATE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76513-6257
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-778-4811
Provider Business Mailing Address Fax Number:
254-743-0110

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1901 S 1ST ST # 122
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76504-7451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-778-4811
Provider Business Practice Location Address Fax Number:
254-743-0110
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETEK
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OF SOCIAL WORK SERVICE
Authorized Official Telephone Number:
254-778-4811

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  S19559 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: S19559 . This is a "SOCIAL WORK LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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