Provider Demographics
NPI:1205092533
Name:VICTORY EMS, INC.
Entity type:Organization
Organization Name:VICTORY EMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING AGENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MATILDA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:NZEOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-661-4848
Mailing Address - Street 1:2600 S LOOP W
Mailing Address - Street 2:630
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77054-2653
Mailing Address - Country:US
Mailing Address - Phone:713-661-4848
Mailing Address - Fax:
Practice Address - Street 1:2600 S LOOP W
Practice Address - Street 2:630
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77054-2653
Practice Address - Country:US
Practice Address - Phone:713-661-4848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10001463416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAMB 739Medicare PIN