Provider Demographics
NPI:1427106103
Name:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Entity type:Organization
Organization Name:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOURTNEY
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:361-579-1305
Mailing Address - Street 1:2710 HOSPITAL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5743
Mailing Address - Country:US
Mailing Address - Phone:361-579-1305
Mailing Address - Fax:361-579-1311
Practice Address - Street 1:2710 HOSPITAL DR STE 202
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-5743
Practice Address - Country:US
Practice Address - Phone:361-579-1305
Practice Address - Fax:361-579-1311
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITIZENS MEDICAL CENTER COUNTY OF VICTORIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-08
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX012107101Medicaid
TX023496501Medicaid
TX012107101Medicaid