Healthcare Provider Details

I. General information

NPI: 1659642635
Provider Name (Legal Business Name): VICTORY MEDICAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2012
Last Update Date: 01/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7953 N COLTRANE LN
TUCSON AZ
85743-7330
US

IV. Provider business mailing address

7953 N COLTRANE LN
TUCSON AZ
85743-7330
US

V. Phone/Fax

Practice location:
  • Phone: 520-334-0100
  • Fax:
Mailing address:
  • Phone: 520-334-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: MR. KIRK TJALAS
Title or Position: RN CEO
Credential: RN
Phone: 520-334-0100