Provider Demographics
NPI:1710936331
Name:VICTORIA SURGICAL ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:VICTORIA SURGICAL ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:361-575-6396
Mailing Address - Street 1:601 E SAN ANTONIO ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-6052
Mailing Address - Country:US
Mailing Address - Phone:361-575-6396
Mailing Address - Fax:361-575-2728
Practice Address - Street 1:601 E SAN ANTONIO ST
Practice Address - Street 2:SUITE 501
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-6052
Practice Address - Country:US
Practice Address - Phone:361-575-6396
Practice Address - Fax:361-575-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX083720501Medicaid
TXCP2130OtherRAILROAD MEDICARE
TX00L365OtherBLUECROSS BLUESHIELD
TX004168OtherKIDNEY HEALTHCARE
TX083720501Medicaid
TX0283840001Medicare NSC