Organization
VICTORIA OF TEXAS LP
Active
Other names
DeTar Hospital Navarro
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(877) 892-9813
Entity
Organization
Contact information
Practice address
506 E SAN ANTONIO ST, VICTORIA, TX 77901-6060
(361) 575-7441
(361) 788-6114
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
—
—
207RH0003X
Hematology & Oncology Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
187389502
—
TX
Enumeration date
09/29/2006
Last updated
06/30/2011
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