Victoria of Texas LP

Key facts

NPI

1619172467

Entity type

Organization (NPI type 2)

Primary specialty

Emergency Medicine Physician 207P00000X

Legal business name

VICTORIA OF TEXAS LP

Practice address

605 E San Antonio St
Suite 310E
Victoria, TX 77901-6040

Phone

(361) 575-0228

Fax

(361) 575-0782

NPI assigned

Jun 20, 2007

Organization subpart

Yes

Parent organization (as reported)

VICTORIA OF TEXAS LP

Authorized official

Name

Debbie Brewer

Title

Director of Provider Enrollment

Phone

(877) 892-9813

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Victoria of Texas LP Rehabilitation Hospital Unit · Victoria, TX · NPI 1053366625
  NPD member Member Of

National Provider Directory

Part of

Robert Simpkins MD

Specialties & licenses

Addresses

Other identifiers

Other names

• DeTar Senior Care Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 30, 2011.

{
    "created_epoch": "1182297600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1309392000000",
    "number": "1619172467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 689022",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370689022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 E SAN ANTONIO ST",
            "address_2": "SUITE 310E",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779016040",
            "telephone_number": "361-575-0228",
            "fax_number": "361-575-0782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORIA OF TEXAS LP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VICTORIA OF TEXAS LP",
        "enumeration_date": "2007-06-20",
        "last_updated": "2011-06-30",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "093825001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "00GT06",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DeTar Senior Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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