Provider Demographics
NPI:1366686263
Name:DETAR HOSPITAL
Entity Type:Organization
Organization Name:DETAR HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NUTRITION MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:READ
Authorized Official - Last Name:SOMMERFELD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RD, LD
Authorized Official - Phone:361-788-6073
Mailing Address - Street 1:506 E SAN ANTONIO ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6060
Mailing Address - Country:US
Mailing Address - Phone:361-788-6073
Mailing Address - Fax:361-788-6174
Practice Address - Street 1:506 E SAN ANTONIO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6060
Practice Address - Country:US
Practice Address - Phone:361-788-6073
Practice Address - Fax:361-788-6174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI875205282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital