Provider Demographics
NPI:1467461897
Name:VICTORIA RADIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:VICTORIA RADIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:TIBBITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:361-578-0317
Mailing Address - Street 1:PO BOX 3610
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77903-3610
Mailing Address - Country:US
Mailing Address - Phone:361-578-0317
Mailing Address - Fax:361-578-8142
Practice Address - Street 1:2710 HOSPITAL DR
Practice Address - Street 2:SUITE 110
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5743
Practice Address - Country:US
Practice Address - Phone:361-578-0317
Practice Address - Fax:361-578-8142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP3083OtherRAILROAD MEDICARE
00L943OtherBLUE CROSS
TX127283301Medicaid
00L943Medicare ID - Type Unspecified