Healthcare Provider Details

I. General information

NPI: 1982662862
Provider Name (Legal Business Name): VICTORY MEDICAL EQUIPMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 09/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E MAIN ST
TISHOMINGO OK
73460-2350
US

IV. Provider business mailing address

710 E MAIN ST
TISHOMINGO OK
73460-2350
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-0340
  • Fax: 580-371-0342
Mailing address:
  • Phone: 580-371-0340
  • Fax: 580-371-0342

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: MRS. JOAN WEEMS
Title or Position: OWNER
Credential: R.N.
Phone: 580-371-0340