Provider Demographics
NPI:1205801057
Name:VIC-CHAR CORP
Entity type:Organization
Organization Name:VIC-CHAR CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RCP
Authorized Official - Phone:661-942-0455
Mailing Address - Street 1:44814 DATE AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-3185
Mailing Address - Country:US
Mailing Address - Phone:661-942-0455
Mailing Address - Fax:661-723-1016
Practice Address - Street 1:44814 DATE AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3185
Practice Address - Country:US
Practice Address - Phone:661-942-0455
Practice Address - Fax:661-723-1016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101203332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31569ZMedicaid
0167560001Medicare ID - Type Unspecified