Provider Demographics
NPI:1578690616
Name:VICTORY MEDICAL EQUIPMENT OF TEXAS, LLC
Entity Type:Organization
Organization Name:VICTORY MEDICAL EQUIPMENT OF TEXAS, LLC
Other - Org Name:VICTORY MEDICAL EQUIPMENT OF TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-371-2002
Mailing Address - Street 1:301 W. SAM RAYBURN
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4237
Mailing Address - Country:US
Mailing Address - Phone:903-583-3562
Mailing Address - Fax:903-583-8636
Practice Address - Street 1:301 W. SAM RAYBURN
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418-4237
Practice Address - Country:US
Practice Address - Phone:903-583-3562
Practice Address - Fax:903-583-8636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332BX2000X
TX0099790332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1921652Medicaid
6059030001Medicare NSC
6059030001Medicare UPIN