Department of Veterans Affairs

Primary specialty

Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X

License

L29493 Issued in AR

Legal business name

DEPARTMENT OF VETERANS AFFAIRS

Practice address

910 Realtor Avenue
Texarkana, AR 71854-5066

Phone

(870) 824-4181

NPI assigned

May 1, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Timothy D. Greathouse, L.P.N.

Title

Staff Nurse

Phone

(870) 216-2512

Specialties & licenses 1

Addresses

Tax ID family

James a Haley Veterans' Hospital179 organizations share this tax ID, including this one

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1209600000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209600000000",
    "number": "1417123258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 LOCUST ST",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545066",
            "telephone_number": "903-824-4181"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "910 REALTOR AVENUE",
            "city": "TEXARKANA",
            "state": "AR",
            "postal_code": "718545066",
            "telephone_number": "870-824-4181"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEPARTMENT OF VETERANS AFFAIRS",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-01",
        "last_updated": "2008-05-01",
        "status": "A",
        "authorized_official_last_name": "GREATHOUSE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "STAFF NURSE",
        "authorized_official_telephone_number": "870-216-2512",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "L.P.N."
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "AR",
            "license": "L29493",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Department of Health and Human Services
• Department of Health and Human Services
• Department of Health and Human Services
• Department of Health and Human Services
• Department of Health and Human Services
• Ashley Derrick, MHPP
• Brittany Lynn Devenney, APRN
• Kyle I Diaz, MD
• Jade Perkins Dickens, LAC
• Robbin Renee Dickson

• Federally Qualified Health Center (FQHC) in Texarkana, AR
• Providers in Texarkana, AR by specialty
• Federally Qualified Health Center (FQHC) in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.