Provider Demographics
NPI:1336135755
Name:VICTORY ASSOCIATES LTD, INC.
Entity Type:Organization
Organization Name:VICTORY ASSOCIATES LTD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:O
Authorized Official - Last Name:OGIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-399-4177
Mailing Address - Street 1:PO BOX 300692
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-0692
Mailing Address - Country:US
Mailing Address - Phone:303-399-4177
Mailing Address - Fax:303-399-0500
Practice Address - Street 1:6403 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1603
Practice Address - Country:US
Practice Address - Phone:303-399-4177
Practice Address - Fax:303-399-0500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-21
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO014306OtherDME/HME SUPPLY PROVVIDER
CO08002032Medicaid