Provider Demographics
NPI:1871778100
Name:M.E.DEBAKEY VETERANS HOSPITAL
Entity type:Organization
Organization Name:M.E.DEBAKEY VETERANS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN/CONSULT COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELYN
Authorized Official - Middle Name:LORRAINE
Authorized Official - Last Name:STARKS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-791-1414
Mailing Address - Street 1:7962 DAWNRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77071-2503
Mailing Address - Country:US
Mailing Address - Phone:713-729-6480
Mailing Address - Fax:
Practice Address - Street 1:2002 HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4211
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:2008-01-05
Last Update Date:2008-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX454837282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX454837OtherRN LICENSE