1124052162 NPI number — CITIZENS MEDICAL CENTER COUNTY OF VICTORIA

Table of content: (NPI 1124052162)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124052162 NPI number — CITIZENS MEDICAL CENTER COUNTY OF VICTORIA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
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:
COUNTY OF VICTORIA CITIZENS MEDICAL CENTER
Provider Other Organization Name Type Code:
4
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:
1124052162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2701 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901-5748
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-573-9181
Provider Business Mailing Address Fax Number:
361-572-5126

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-5748
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-573-9181
Provider Business Practice Location Address Fax Number:
361-572-5126
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
361-572-5113

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000064 , 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: 137907508 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0234 . This is a "BLUE CROSS BLUE SHIELD OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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