Healthcare Provider Details

I. General information

NPI: 1225949258
Provider Name (Legal Business Name): VICTORY TRANSPORTATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 E SANTA FE ST LOT 284
GARDNER KS
66030-1664
US

IV. Provider business mailing address

4601 E DOUGLAS AVE STE 150
WICHITA KS
67218-1011
US

V. Phone/Fax

Practice location:
  • Phone: 785-979-8363
  • Fax:
Mailing address:
  • Phone: 785-979-8363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code344600000X
TaxonomyTaxi
License Number
License Number State

VIII. Authorized Official

Name: MR. VERNON EARL RIDDLE
Title or Position: SOLE MEMBER
Credential:
Phone: 785-979-8363