Provider Demographics
NPI:1619174158
Name:VICTORY HOME MEDICAL
Entity Type:Organization
Organization Name:VICTORY HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OGLESBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-546-6500
Mailing Address - Street 1:400 W MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5346
Mailing Address - Country:US
Mailing Address - Phone:337-546-6500
Mailing Address - Fax:337-457-4750
Practice Address - Street 1:400 W MAPLE AVE
Practice Address - Street 2:
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5346
Practice Address - Country:US
Practice Address - Phone:337-546-6500
Practice Address - Fax:337-457-4750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAG0973OtherBLUE CROSS
LA1566659Medicaid
LA1300600001Medicare NSC