Provider Demographics
NPI:1770058265
Name:VICTORY MEDICAL TRANSPORTATION, INC.
Entity type:Organization
Organization Name:VICTORY MEDICAL TRANSPORTATION, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:TANGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MALOOF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-636-5055
Mailing Address - Street 1:29222 RANCHO VIEJO RD STE 127
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-1049
Mailing Address - Country:US
Mailing Address - Phone:949-426-3767
Mailing Address - Fax:
Practice Address - Street 1:3604 S BANNER ST STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-4316
Practice Address - Country:US
Practice Address - Phone:208-401-1400
Practice Address - Fax:208-401-1401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-10
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No3416A0800XTransportation ServicesAmbulanceAir Transport
No343800000XTransportation ServicesSecured Medical Transport (VAN)
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No341600000XTransportation ServicesAmbulance