Provider Demographics
NPI:1235853615
Name:VICTORY PEDIATRICS LLC
Entity Type:Organization
Organization Name:VICTORY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD /OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CAREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-301-1822
Mailing Address - Street 1:3929 AIRPORT BLVD STE 2-413
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-2239
Mailing Address - Country:US
Mailing Address - Phone:251-301-1822
Mailing Address - Fax:251-301-5571
Practice Address - Street 1:3929 AIRPORT BLVD STE 2-413
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-2239
Practice Address - Country:US
Practice Address - Phone:251-301-1822
Practice Address - Fax:251-301-5571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-29
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty