Provider Demographics
NPI:1912764309
Name:VICTOR MEDICAL CORPORATION
Entity type:Organization
Organization Name:VICTOR MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-220-4800
Mailing Address - Street 1:1234 6TH ST APT 100
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1657
Mailing Address - Country:US
Mailing Address - Phone:310-451-8880
Mailing Address - Fax:310-451-8803
Practice Address - Street 1:1234 6TH ST APT 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1657
Practice Address - Country:US
Practice Address - Phone:310-451-8880
Practice Address - Fax:310-451-8803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty