| Bangaruswamy Vijaya Kumar | |
|
601 E San Antonio St Suite 403w Victoria TX 77901-6040 | |
| (361) 580-1500 | |
| (361) 580-1507 |
| Full Name | Bangaruswamy Vijaya Kumar |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 601 E San Antonio St, Victoria, Texas |
| Authorized Official Name and Position | Bangaruswamy Kumar (OFFICE MANAGER) |
| Authorized Official Contact | 3619358470 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bangaruswamy Vijaya Kumar 2206 Valley Blossum Ln League City TX 77573-3977 Ph: (361) 935-8470 | Bangaruswamy Vijaya Kumar 601 E San Antonio St Suite 403w Victoria TX 77901-6040 Ph: (361) 580-1500 |
| NPI Number | 1659560746 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 02/25/2022 |
| Certification Date | 02/25/2022 |
| Medicare PECOS PAC ID | 1052443959 |
|---|---|
| Medicare Enrollment ID | O20100712000634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1659560746 | NPI | - | NPPES |
| 0067EW | Other | TX | BCBS |
| 5252513 | Other | TX | AETNA |
| 097036001 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084A0401X | Psychiatry & Neurology - Addiction Medicine | (* (Not Available)) | Primary |
| Provider Name | Bangaruswamy V Kumar |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1427160324 PECOS PAC ID: 6709803612 Enrollment ID: I20100628000350 |
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