MEDICARE: VAL VERDE COUNTY HOSPITAL DISTRICT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	313M00000X	Nursing Facility/Intermediate Care Facility	TX
2	332B00000X	Durable Medical Equipment & Medical Supplies
3	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801160593
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAL VERDE COUNTY HOSPITAL DISTRICT

Provider Business Mailing Address
First Line	:	101 W GOODWIN AVE
Second Line	:	STE 600
City	:	VICTORIA
State	:	TX
Zip	:	77901-6502
Country	:	US
Telephone Number	:	361-576-0694
Fax Number	:	361-576-5484

Provider Business Practice Location Address
First Line	:	3030 ROOSEVELT AVE
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78214-2337
Country	:	US
Telephone Number	:	210-924-8151
Fax Number	:	210-924-2208

Authorized Official
Title or Position	:	CHAIRMAN
Name	:	MR. ANTONIO SOTELO
Credential	:
Telephone Number	:	830-775-8566

Provider Enumeration Date	:	02/28/2012
Last Update Date	:	06/19/2015

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Directions to “VAL VERDE COUNTY HOSPITAL DISTRICT ” Practice Location

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