1639317985 NPI number — VICTFORCE, INC

Table of content: (NPI 1639317985)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639317985 NPI number — VICTFORCE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTFORCE, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WINDERMERE MEDICAL CLINIC AND SPA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639317985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1535 BOOMER CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-6610
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-957-9283
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3850 WINDERMERE PKWY
Provider Second Line Business Practice Location Address:
SUITE #105
Provider Business Practice Location Address City Name:
CUMMING
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30041-7002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
404-374-1796
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/24/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BAYYAPUREDDY
Authorized Official First Name:
PRIYA
Authorized Official Middle Name:
VAMSI
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
404-374-1796

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  055177 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)