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General NPI Number Information
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NPI Number | 1366686263
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Entity Type | Organization
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Legal Business Name | DETAR HOSPITAL
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Dates
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Enumeration Date | 04/23/2009
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Last Update Date | 04/23/2009
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Provider Practice Location Address
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Address Line | 506 E SAN ANTONIO ST
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City | VICTORIA
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State | TX
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Zip | 77901-6060
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Country | US
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Telephone | 361-788-6073
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Fax | 361-788-6174
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Provider Business Mailing Address
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Address Line | 506 E SAN ANTONIO ST
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City | VICTORIA
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State | TX
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Zip | 77901-6060
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Country | US
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Telephone | 361-788-6073
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Fax | 361-788-6174
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Authorized Official
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Title or Position | CLINICAL NUTRITION MANAGER
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Name | MRS. ELIZABETH READ SOMMERFELD
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Credential | MS, RD, LD
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Telephone | 361-788-6073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | 875205
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License Number State | MI
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