Basic Information
| Provider Information | |||||||||
| NPI: | 1265922884 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BONE HEALTH CLINIC OF VICTORIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 606 E NUECES ST | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779015087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615754100 | ||||||||
| FaxNumber: | 3615754111 | ||||||||
| Practice Location | |||||||||
| Address1: | 606 E NUECES ST | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 77901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615754100 | ||||||||
| FaxNumber: | 3615754111 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2018 | ||||||||
| LastUpdateDate: | 08/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | STINES | ||||||||
| AuthorizedOfficialFirstName: | LAWRENCE | ||||||||
| AuthorizedOfficialMiddleName: | CHRIS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3615754100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM2500X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty |
No ID Information.