Provider Demographics
NPI:1851343909
Name:VICTORIA OF TEXAS LP
Entity Type:Organization
Organization Name:VICTORIA OF TEXAS LP
Other - Org Name:DETAR HEALTHCARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR/DELEGATED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:629-215-3953
Mailing Address - Street 1:PO BOX 2089
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77902-2089
Mailing Address - Country:US
Mailing Address - Phone:361-575-7441
Mailing Address - Fax:361-788-6114
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:361-575-7441
Practice Address - Fax:361-788-2693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X, 261QC0050X
TX000453282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QC0050XAmbulatory Health Care FacilitiesClinic/CenterCritical Access Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0941189-02Medicaid
TX0941189-01Medicaid
TX0941189-01Medicaid