Organization Name: | VICTORY LAKES MEDICAL CENTER |
NPI Number: | 1104206101 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TIM FIELDING (CFO) |
Mailing Address: | 1535 W Fm 646 League City |
State: | TX US |
Postal Code: | 775730000 |
Phone Number: | 9728996650 |
Fax Number: | |
NPI Enumeration Date: | 06/04/2015 |
NPI Last Update Date: | 06/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QE0002X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Emergency Care |
Taxonomy Definition: |