Provider Demographics
NPI:1417062225
Name:VICTORIA ORTHOPEDIC & SPORTS MEDICINE CLINIC, LLC
Entity Type:Organization
Organization Name:VICTORIA ORTHOPEDIC & SPORTS MEDICINE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELNDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:SPEED
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-576-0633
Mailing Address - Street 1:605 E SAN ANTONIO ST
Mailing Address - Street 2:STE 520E
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6040
Mailing Address - Country:US
Mailing Address - Phone:361-576-0633
Mailing Address - Fax:367-576-0639
Practice Address - Street 1:605 E SAN ANTONIO ST
Practice Address - Street 2:STE 520E
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6040
Practice Address - Country:US
Practice Address - Phone:361-576-0633
Practice Address - Fax:367-576-0639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00211VMedicare ID - Type Unspecified
TXC15007Medicare UPIN
TXF52162Medicare UPIN
TXC20376Medicare UPIN
TXH83994Medicare UPIN