Provider Demographics
NPI:1417334624
Name:VICTORIAN MEDICAL TRANSPORT INC
Entity Type:Organization
Organization Name:VICTORIAN MEDICAL TRANSPORT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-379-8633
Mailing Address - Street 1:1644 CEDAR BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75253-4846
Mailing Address - Country:US
Mailing Address - Phone:972-379-8633
Mailing Address - Fax:469-620-2370
Practice Address - Street 1:1644 CEDAR BLUFF LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75253-4846
Practice Address - Country:US
Practice Address - Phone:972-379-8633
Practice Address - Fax:469-620-2370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-27
Last Update Date:2015-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)