MEDICARE: VICTORIA MARIE GROUNDS P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant
2	363A00000X	Physician Assistant	PA09110	TX

General Provider Information

NPI Number	:	1144588872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MARIE GROUNDS P.A.

Provider Business Mailing Address
First Line	:	PO BOX 1610
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-1610
Country	:	US
Telephone Number	:	903-603-7067
Fax Number	:	903-603-7595

Provider Business Practice Location Address
First Line	:	801 W MAIN ST
Second Line	:
City	:	GUN BARREL CITY
State	:	TX
Zip	:	75156-5312
Country	:	US
Telephone Number	:	903-887-1011
Fax Number	:	903-603-9441

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2012
Last Update Date	:	04/22/2025

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1033506019 — MRS. ALICE RENEE SPLINTER MD
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Directions to “ VICTORIA MARIE GROUNDS P.A.” Practice Location

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