Provider Demographics
NPI:1467515668
Name:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Entity Type:Organization
Organization Name:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Other - Org Name:CITIZENS MEDICAL CENTER SKILLED NURSING UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-572-5113
Mailing Address - Street 1:2701 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5748
Mailing Address - Country:US
Mailing Address - Phone:361-573-9181
Mailing Address - Fax:361-572-5126
Practice Address - Street 1:2701 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5748
Practice Address - Country:US
Practice Address - Phone:361-573-9181
Practice Address - Fax:361-572-5126
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-18
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000064314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
675086Medicare ID - Type Unspecified