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Organization
VICTOR SONGBANDITH LLC
Active
Organization
VICTOR SONGBANDITH LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VICTOR SONGBANDITH MD (PARTNER)
(915) 241-4734
Entity
Organization
Contact information
Practice address
101 NORTH ERMA, PRESIDIO, TX 79845-0693
(432) 229-4246
(432) 229-4249
Mailing address
3022 TRAWOOD DR, EL PASO, TX 79936-4329
(915) 241-4734
(915) 855-3311
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
L0612
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
213263101
MEDICAID PART A
TX
01
—
213263102
MEDICAID PART B
TX
01
—
673912
MEDICARE PART A PTAN
TX
01
—
TXB161127
MEDICARE PART B
TX
Enumeration date
03/06/2009
Last updated
07/03/2013
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