Healthcare Provider Details

I. General information

NPI: 1003387689
Provider Name (Legal Business Name): VICTUS PHYSICIAN SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12607 OLIVE BLVD
SAINT LOUIS MO
63141-6313
US

IV. Provider business mailing address

13236 N 7TH ST STE 4
PHOENIX AZ
85022-5343
US

V. Phone/Fax

Practice location:
  • Phone: 314-327-8070
  • Fax:
Mailing address:
  • Phone: 314-378-5422
  • Fax: 314-228-1891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: EMILY ELIZABETH HELLING
Title or Position: OWNER
Credential:
Phone: 314-378-5422