Provider Demographics
NPI:1558961334
Name:VICTORIOUS MEDICAL SERVICES , LLC
Entity Type:Organization
Organization Name:VICTORIOUS MEDICAL SERVICES , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KENEISHA
Authorized Official - Middle Name:S
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:713-481-8857
Mailing Address - Street 1:8426 MANASSAS LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77083-6362
Mailing Address - Country:US
Mailing Address - Phone:713-481-8857
Mailing Address - Fax:713-481-8430
Practice Address - Street 1:8426 MANASSAS LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77083-6362
Practice Address - Country:US
Practice Address - Phone:832-498-7491
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-29
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive Care
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4212102Medicaid