Organization
VICTORIA RADIOLOGY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN W TIBBITTS M.D. (PARTNER)
(361) 578-0317
Entity
Organization
Contact information
Practice address
2710 HOSPITAL DR, SUITE 110, VICTORIA, TX 77901-5743
(361) 578-0317
(361) 578-8142
Mailing address
PO BOX 3610, VICTORIA, TX 77903-3610
(361) 578-0317
(361) 578-8142
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00L943
BLUE CROSS
—
05
—
127283301
—
TX
01
—
CP3083
RAILROAD MEDICARE
—
Enumeration date
08/05/2006
Last updated
04/24/2014
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