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General NPI Number Information
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NPI Number | 1275840407
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Entity Type | Organization
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Legal Business Name | VICTORY MEDICAL EQUIPMENT OF TX
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Dates
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Enumeration Date | 09/09/2010
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Last Update Date | 09/09/2010
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Provider Practice Location Address
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Address Line | 2501 N CENTER ST SUITE 105
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City | BONHAM
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State | TX
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Zip | 75418-2114
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Country | US
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Telephone | 903-583-3562
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Fax | 903-583-8636
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Provider Business Mailing Address
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Address Line | 809 GALLAGHER DR SUITE D
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City | SHERMAN
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State | TX
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Zip | 75090-3111
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Country | US
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Telephone | 903-868-0308
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Fax | 903-868-0207
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JUDY K BOLEN
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Credential |
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Telephone | 903-868-0308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0099790
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License Number State | TX
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