Basic Information
| Provider Information | |||||||||
| NPI: | 1659316115 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | POST ACUTE MEDICAL AT VICTORIA LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | PAM SPECIALTY HOSPITAL OF VICTORIA SOUTHEAST | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1828 GOOD HOPE RD | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | ENOLA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170251233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177319660 | ||||||||
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| Practice Location | |||||||||
| Address1: | 102 MEDICAL DR | ||||||||
| Address2: | |||||||||
| City: | VICTORIA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 779043101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3615766200 | ||||||||
| FaxNumber: | 3615729296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 09/07/2022 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MISITANO | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7177319660 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 09/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | N | Hospitals | Long Term Care Hospital | 284300000X | 000831 | TX | Y | Hospitals | Special Hospital |
ID Information
| ID | Type | State | Issuer | Description | 1991838-01 | 05 | TX | MEDICAID | 0211807-02 | 05 | TX | MEDICAID | 1991838-03 | 05 | TX | MEDICAID |