Provider Demographics
NPI:1639722598
Name:VICTORY TRANSPORTATION
Entity Type:Organization
Organization Name:VICTORY TRANSPORTATION
Other - Org Name:VICTORY TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARD-PAPILLION
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:337-439-1868
Mailing Address - Street 1:3207 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70615-3805
Mailing Address - Country:US
Mailing Address - Phone:337-439-1868
Mailing Address - Fax:
Practice Address - Street 1:3537 POWER CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70607-7565
Practice Address - Country:US
Practice Address - Phone:337-439-1868
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)