Healthcare Provider Details

I. General information

NPI: 1790822260
Provider Name (Legal Business Name): VICTORY MEDICAL EQUIPMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1323 S. BROADWAY
MARLOW OK
73055
US

IV. Provider business mailing address

1323 S. BROADWAY
MARLOW OK
73055
US

V. Phone/Fax

Practice location:
  • Phone: 580-658-1068
  • Fax: 580-658-1054
Mailing address:
  • Phone: 580-658-1068
  • Fax: 580-658-1054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BILL JETER
Title or Position: OPERATIONS
Credential:
Phone: 580-931-3707