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Organization
VICTORIA OF TEXAS LP
Active
Organization
VICTORIA OF TEXAS LP
Active
Other names
DeTar Hospital North Emergency Department
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
101 MEDICAL DR, VICTORIA, TX 77904-3102
(361) 573-6100
(361) 788-2693
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00401R
BLUE CROSS
—
05
—
143687501
—
TX
05
—
143687502
—
TX
Enumeration date
06/20/2007
Last updated
06/30/2011
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