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General NPI Number Information
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NPI Number | 1639421340
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Entity Type | Organization
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Legal Business Name | VICTORY EMS, INC
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 10/23/2013
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Provider Practice Location Address
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Address Line | 1275 N AIR DEPOT BLVD
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City | MIDWEST CITY
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State | OK
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Zip | 73110-3333
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Country | US
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Telephone | 405-732-4600
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Fax | 405-732-4600
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Provider Business Mailing Address
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Address Line | 1275 N AIR DEPOT BLVD
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City | MIDWEST CITY
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State | OK
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Zip | 73110-3333
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Country | US
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Telephone | 405-732-4600
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Fax | 405-732-4602
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JOE WEAVER
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Credential |
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Telephone | 918-977-0409
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 472
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License Number State | OK
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