Basic Information
| Provider Information | |||||||||
| NPI: | 1689730293 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VICTOR H. HILDYARD II, MD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | COLBY MEDICAL & SURGICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 SOUTH RANGE | ||||||||
| Address2: | |||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854623332 | ||||||||
| FaxNumber: | 7854623337 | ||||||||
| Practice Location | |||||||||
| Address1: | 175 SOUTH RANGE | ||||||||
| Address2: | |||||||||
| City: | COLBY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854623332 | ||||||||
| FaxNumber: | 7854623337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/28/2006 | ||||||||
| LastUpdateDate: | 01/25/2012 | ||||||||
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| AuthorizedOfficialLastName: | HILDYARD | ||||||||
| AuthorizedOfficialFirstName: | BRENDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7854623332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | KS | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 100087830A | 05 | KS | MEDICAID |