Provider Demographics
NPI:1982662862
Name:VICTORY MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:VICTORY MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEEMS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:580-371-0340
Mailing Address - Street 1:710 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TISHOMINGO
Mailing Address - State:OK
Mailing Address - Zip Code:73460-2350
Mailing Address - Country:US
Mailing Address - Phone:580-371-0340
Mailing Address - Fax:580-371-0342
Practice Address - Street 1:710 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TISHOMINGO
Practice Address - State:OK
Practice Address - Zip Code:73460-2350
Practice Address - Country:US
Practice Address - Phone:580-371-0340
Practice Address - Fax:580-371-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5273700001Medicare ID - Type Unspecified