1164867198 NPI number — VICTORY MEDICAL CENTER CRAIG RANCH, LP

Table of content: (NPI 1164867198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164867198 NPI number — VICTORY MEDICAL CENTER CRAIG RANCH, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY MEDICAL CENTER CRAIG RANCH, LP
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:
Provider Other Organization Name Type Code:
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:
1164867198
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
09/29/2015
NPI Reactivation Date:
11/06/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2201 TIMBERLOCH PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THE WOODLANDS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-863-2100
Provider Business Mailing Address Fax Number:
281-292-2773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6045 ALMA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-2188
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-863-2100
Provider Business Practice Location Address Fax Number:
281-292-2773
Provider Enumeration Date:
05/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
BELINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
281-863-2100

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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