1366866477 NPI number — VICTORIA PROFESSIONAL MEDICAL CONSULTANTS, LLC

Table of content: (NPI 1366866477)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366866477 NPI number — VICTORIA PROFESSIONAL MEDICAL CONSULTANTS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORIA PROFESSIONAL MEDICAL CONSULTANTS, LLC
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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1366866477
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3689
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77487-3310
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-962-3303
Provider Business Mailing Address Fax Number:
405-682-1586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
815 N VIRGINIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT LAVACA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77979-3025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-552-6713
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ZIMMERMAN
Authorized Official First Name:
BRETT
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
205-240-1159

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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