Provider Demographics
NPI:1326483819
Name:VICTORY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:VICTORY HEALTH CENTER LLC
Other - Org Name:VICTORY MEDICAL & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KEKKI
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:314-276-4506
Mailing Address - Street 1:1306 BELL RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:ROSENBERG
Mailing Address - State:TX
Mailing Address - Zip Code:77471-6608
Mailing Address - Country:US
Mailing Address - Phone:281-497-3224
Mailing Address - Fax:281-497-3225
Practice Address - Street 1:13711 WESTHEIMER RD STE B3
Practice Address - Street 2:WEST OAKS PLACE SHOPPING CENTER BY ELD
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5369
Practice Address - Country:US
Practice Address - Phone:281-497-3224
Practice Address - Fax:281-497-3225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-09
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX807741208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty