Provider Demographics
NPI:1134140874
Name:CARDIOVASCULAR ASSOCIATES OF VICTORIA P.A.
Entity Type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES OF VICTORIA P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:TUMLINSON
Authorized Official - Suffix:
Authorized Official - Credentials:CAPPM
Authorized Official - Phone:361-573-0756
Mailing Address - Street 1:4502 N LAURENT ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2709
Mailing Address - Country:US
Mailing Address - Phone:361-573-0756
Mailing Address - Fax:361-573-0633
Practice Address - Street 1:4502 N LAURENT ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2709
Practice Address - Country:US
Practice Address - Phone:361-573-0756
Practice Address - Fax:361-573-0633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00R17RMedicare ID - Type Unspecified