Healthcare Provider Details

I. General information

NPI: 1164480992
Provider Name (Legal Business Name): VICTORIA SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 JAMES COLEMAN DR
VICTORIA TX
77904-3100
US

IV. Provider business mailing address

105 JAMES COLEMAN DR
VICTORIA TX
77904-3100
US

V. Phone/Fax

Practice location:
  • Phone: 361-578-0234
  • Fax: 361-578-3812
Mailing address:
  • Phone: 361-578-0234
  • Fax: 361-578-3812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number000396
License Number StateTX

VIII. Authorized Official

Name: LESLEY MICHELLE ALSTROM
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 361-578-0234