| Popcorn Plus | |
|
4702 N Laurent St Suite D Victoria TX 77904-2147 | |
| (361) 572-0202 | |
| (361) 572-0300 |
| Full Name | Popcorn Plus |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 4702 N Laurent St, Victoria, Texas |
| Authorized Official Name and Position | Delores Evens White (DIRECTOR) |
| Authorized Official Contact | 3615720202 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Popcorn Plus 4702 N Laurent St Suite D Victoria TX 77904-2147 Ph: (361) 572-0202 | Popcorn Plus 4702 N Laurent St Suite D Victoria TX 77904-2147 Ph: (361) 572-0202 |
| NPI Number | 1174076046 |
|---|---|
| Provider Enumeration Date | 07/27/2016 |
| Last Update Date | 07/27/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174076046 | NPI | - | NPPES |
| 305544401 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 66862 (Texas) | Primary |
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