Provider Demographics
NPI:1407611650
Name:VICTORY NON-EMERGENCY MEDICAL TRANSPORT
Entity Type:Organization
Organization Name:VICTORY NON-EMERGENCY MEDICAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:VICTORY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-809-1439
Mailing Address - Street 1:2031 ROSEMARY DR
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-6559
Mailing Address - Country:US
Mailing Address - Phone:831-809-1439
Mailing Address - Fax:
Practice Address - Street 1:2031 ROSEMARY DR
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-6559
Practice Address - Country:US
Practice Address - Phone:831-809-1439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-16
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)