Healthcare Provider Details

I. General information

NPI: 1144641234
Provider Name (Legal Business Name): CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

524 VILLAGE RD
PORT LAVACA TX
77979-2380
US

IV. Provider business mailing address

2701 HOSPITAL DR
VICTORIA TX
77901-5748
US

V. Phone/Fax

Practice location:
  • Phone: 361-552-3741
  • Fax: 361-552-5808
Mailing address:
  • Phone: 361-573-9181
  • Fax: 361-572-5126

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: MR. MICHAEL OLSON
Title or Position: CEO/ADMINISTRATOR
Credential:
Phone: 361-573-9181