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Organization
VICTORIA OF TEXAS LP
Active
Organization
VICTORIA OF TEXAS LP
Active
Other names
DeTar Hospital Navarro
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
506 E SAN ANTONIO ST, VICTORIA, TX 77901-6060
(361) 575-7441
(361) 788-6114
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187389502
—
TX
Enumeration date
09/29/2006
Last updated
06/30/2011
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