MEDICARE: CITIZENS MEDICAL CENTER COUNTY OF VICTORIA

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	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1073934949
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS MEDICAL CENTER COUNTY OF VICTORIA

Provider Business Mailing Address
First Line	:	2701 HOSPITAL DR
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5748
Country	:	US
Telephone Number	:	361-573-9181
Fax Number	:

Provider Business Practice Location Address
First Line	:	3301 E MOCKINGBIRD LN
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77904-2437
Country	:	US
Telephone Number	:	361-573-3201
Fax Number	:	361-485-9916

Authorized Official
Title or Position	:	CEO
Name	:	STEPHEN THAMES
Credential	:
Telephone Number	:	361-573-9181

Provider Enumeration Date	:	12/19/2013
Last Update Date	:	08/22/2014

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