1326483819 NPI number — VICTORY HEALTH CENTER LLC

Table of content: (NPI 1326483819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326483819 NPI number — VICTORY HEALTH CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VICTORY HEALTH CENTER LLC
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:
Provider Other Organization Name Type Code:
6
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:
1326483819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1306 BELL RIDGE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-6608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-497-3224
Provider Business Mailing Address Fax Number:
281-497-3225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13711 WESTHEIMER RD STE B3
Provider Second Line Business Practice Location Address:
WEST OAKS PLACE SHOPPING CENTER BY ELD
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77077-5369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-497-3224
Provider Business Practice Location Address Fax Number:
281-497-3225
Provider Enumeration Date:
05/09/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KEKKI
Authorized Official First Name:
ESTHER
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE OWNER
Authorized Official Telephone Number:
314-276-4506

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  807741 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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