MEDICARE: VICTORY EMERGENCY PHYSICIANS MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932402716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VICTORY EMERGENCY PHYSICIANS MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4535 DRESSLER RD NW
Second Line	:
City	:	CANTON
State	:	OH
Zip	:	44718-2545
Country	:	US
Telephone Number	:	855-687-0618
Fax Number	:	330-493-8677

Provider Business Practice Location Address
First Line	:	1720 E CESAR E CHAVEZ AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-2481
Country	:	US
Telephone Number	:	855-687-0618
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	STEVEN P. MARON
Credential	:	M.D.
Telephone Number	:	855-687-0618

Provider Enumeration Date	:	12/16/2010
Last Update Date	:	04/06/2022

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