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Organization

COMMUNITY MOTHER AND CHILD HEALTH CENTER

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JUDY GILLEY FNP (MANAGING EMPLOYEE)
(361) 570-1082
Entity
Organization

Contact information

Practice address
510 E RIO GRANDE ST, VICTORIA, TX 77901-6033
(361) 570-1083
Mailing address
510 E RIO GRANDE ST, VICTORIA, TX 77901-6033
(361) 570-1083

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
208D00000X
General Practice Physician
Primary
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00929K
DEACTIVATED
TX
05
0801377601
TX
Enumeration date
07/15/2006
Last updated
12/06/2010
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