Provider Demographics
NPI:1952919961
Name:VICTOR ICU, INC
Entity Type:Organization
Organization Name:VICTOR ICU, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:AVINESH
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHAR JASWINDAR SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-270-6340
Mailing Address - Street 1:1140 S JACKSON SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31211-1439
Mailing Address - Country:US
Mailing Address - Phone:646-270-6340
Mailing Address - Fax:
Practice Address - Street 1:1140 S JACKSON SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31211-1439
Practice Address - Country:US
Practice Address - Phone:646-270-6340
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty