| Victory Clinical Services Ii Llc | |
|
4218 W Western Ave South Bend IN 46619-2622 | |
| (574) 233-1524 | |
| (574) 233-1612 |
| Full Name | Victory Clinical Services Ii Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4218 W Western Ave, South Bend, Indiana |
| Authorized Official Name and Position | David Blankenship (ADMINISTRATIVE DIRECTOR) |
| Authorized Official Contact | 5742331524 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Clinical Services Ii Llc 4218 W Western Ave South Bend IN 46619-2622 Ph: (574) 233-1524 | Victory Clinical Services Ii Llc 4218 W Western Ave South Bend IN 46619-2622 Ph: (574) 233-1524 |
| NPI Number | 1497798284 |
|---|---|
| Provider Enumeration Date | 06/13/2006 |
| Last Update Date | 03/22/2012 |
| Medicare PECOS PAC ID | 5193150274 |
|---|---|
| Medicare Enrollment ID | O20200117001513 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1497798284 | NPI | - | NPPES |
| 1255432233 | Other | IN | WOODWARD NPC - NPI |
| 168750 | Medicaid | IN | |
| 100220790 | Medicaid | IN | |
| 200495610 | Medicaid | IN | |
| 1518055565 | Other | IN | SHEEHAN HSPP - NPI |
| 1982647434 | Other | IN | WANG - NPI |
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