| Dr Samuel Victor Canchola, MD | |
|
110 Heritage Trl, Bellville, TX 77418-9300 | |
| (979) 865-0196 | |
| (979) 865-0198 |
| Full Name | Dr Samuel Victor Canchola |
|---|---|
| Gender | Male |
| Speciality | Emergency Medicine |
| Location | 110 Heritage Trl, Bellville, Texas |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598745242 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207P00000X | Emergency Medicine | F3063 (Texas) | Primary |
| 207Q00000X | Family Medicine | F3063 (Texas) | Secondary |
| Entity Name | Concord Medical Group Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1083630610 PECOS PAC ID: 0446296818 Enrollment ID: O20050707000531 |
| Entity Name | Victoria Emergency Associates Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1407917164 PECOS PAC ID: 7911005087 Enrollment ID: O20070613000507 |
| Entity Name | Concord Medical Group Of Texas Pllc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1750790762 PECOS PAC ID: 7810117223 Enrollment ID: O20141007002567 |
| Entity Name | Sterling Initiatives |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1326452947 PECOS PAC ID: 6709100811 Enrollment ID: O20150121000251 |
| Entity Name | Ess Of Port Lavaca Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1922546936 PECOS PAC ID: 2769766005 Enrollment ID: O20170303001868 |
| Entity Name | Emergency Hospital Systems Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1992172019 PECOS PAC ID: 2567765761 Enrollment ID: O20170607000131 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Samuel Victor Canchola, MD 110 Heritage Trl, Bellville, TX 77418-9300 Ph: (979) 865-0196 | Dr Samuel Victor Canchola, MD 110 Heritage Trl, Bellville, TX 77418-9300 Ph: (979) 865-0196 |