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General NPI Number Information
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NPI Number | 1255020061
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Entity Type | Organization
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Legal Business Name | VICTORY WOUND CARE
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Dates
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Enumeration Date | 05/08/2023
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 14205 N MO PAC EXPY STE 570 PMB 411939
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City | AUSTIN
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State | TX
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Zip | 78728-6529
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Country | US
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Telephone | 737-667-5566
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Fax | 469-312-2506
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Provider Business Mailing Address
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Address Line | 14205 N MO PAC EXPY STE 570 PMB 411939
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City | AUSTIN
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State | TX
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Zip | 78728-6529
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Country | US
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Telephone | 737-667-5566
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Fax | 469-312-2506
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Authorized Official
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Title or Position | MANAGER
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Name | LANCE MCNEILL
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Credential |
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Telephone | 737-667-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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