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Organization
VICTORIA OF TEXAS LP
Active
Organization
VICTORIA OF TEXAS LP
Active
Parent organization
VICTORIA OF TEXAS LP
Other names
DeTar Senior Care Center
Organization subpart
Yes
Provider details
NPI number
Legal business name
VICTORIA OF TEXAS LP
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
605 E SAN ANTONIO ST, SUITE 310E, VICTORIA, TX 77901-6040
(361) 575-0228
(361) 575-0782
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00GT06
BLUE CROSS
—
05
—
093825001
—
TX
Enumeration date
06/20/2007
Last updated
06/30/2011
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