Provider Demographics
NPI:1104430446
Name:VICTORY HEALTH OF ONEONTA LLC
Entity type:Organization
Organization Name:VICTORY HEALTH OF ONEONTA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHERT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:256-582-1066
Mailing Address - Street 1:1231 GUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1841
Mailing Address - Country:US
Mailing Address - Phone:256-582-1066
Mailing Address - Fax:256-582-1053
Practice Address - Street 1:28252 AL-75
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:AL
Practice Address - Zip Code:35121
Practice Address - Country:US
Practice Address - Phone:205-625-3621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty