Provider Demographics
NPI:1073939278
Name:VICTORY HOME MEDICAL INC
Entity Type:Organization
Organization Name:VICTORY HOME MEDICAL INC
Other - Org Name:VICTORY HOME MEDICAL INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-457-5040
Mailing Address - Street 1:731 S C C DUSON ST
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5407
Mailing Address - Country:US
Mailing Address - Phone:337-457-5040
Mailing Address - Fax:337-457-0076
Practice Address - Street 1:731 S C C DUSON ST
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5407
Practice Address - Country:US
Practice Address - Phone:337-457-5040
Practice Address - Fax:337-457-0076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment