Provider Demographics
NPI:1447250725
Name:STATE OF TEXAS VETERANS LAND BOARD
Entity type:Organization
Organization Name:STATE OF TEXAS VETERANS LAND BOARD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN TEXAS VETERANS LAND BOARD
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-475-2336
Mailing Address - Street 1:1700 NORTH CONGRESS AVENUE
Mailing Address - Street 2:RM 810
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701
Mailing Address - Country:US
Mailing Address - Phone:512-936-6929
Mailing Address - Fax:512-475-2294
Practice Address - Street 1:1809 N HIGHWAY 87
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-0793
Practice Address - Country:US
Practice Address - Phone:512-268-8387
Practice Address - Fax:512-268-1987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
100429314000000X
TX67-5874314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX001003133Medicaid
TX001003133Medicaid