Healthcare Provider Details

I. General information

NPI: 1902227747
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2013
Last Update Date: 08/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 SOUTH LANCASTER
MOULTON TX
77975-0120
US

IV. Provider business mailing address

2701 HOSPITAL DR
VICTORIA TX
77901-5748
US

V. Phone/Fax

Practice location:
  • Phone: 361-596-7373
  • Fax: 361-596-7671
Mailing address:
  • Phone: 361-573-9181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN THAMES
Title or Position: CEO
Credential:
Phone: 361-573-9181