Healthcare Provider Details

I. General information

NPI: 1275840407
Provider Name (Legal Business Name): VICTORY MEDICAL EQUIPMENT OF TX
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 09/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N CENTER ST SUITE 105
BONHAM TX
75418-2114
US

IV. Provider business mailing address

809 GALLAGHER DR SUITE D
SHERMAN TX
75090-3111
US

V. Phone/Fax

Practice location:
  • Phone: 903-583-3562
  • Fax: 903-583-8636
Mailing address:
  • Phone: 903-868-0308
  • Fax: 903-868-0207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number0099790
License Number StateTX

VIII. Authorized Official

Name: JUDY K BOLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 903-868-0308