Provider Demographics
NPI:1265922884
Name:BONE HEALTH CLINIC OF VICTORIA PLLC
Entity type:Organization
Organization Name:BONE HEALTH CLINIC OF VICTORIA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:STINES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:361-575-4100
Mailing Address - Street 1:606 E NUECES ST
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5087
Mailing Address - Country:US
Mailing Address - Phone:361-575-4100
Mailing Address - Fax:361-575-4111
Practice Address - Street 1:606 E NUECES ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-575-4100
Practice Address - Fax:361-575-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-18
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty