| Victory Clinical Services Lansing | |
|
4902 S Cedar St Lansing MI 48910-5474 | |
| (517) 394-7867 | |
| (517) 394-7869 |
| Full Name | Victory Clinical Services Lansing |
|---|---|
| Speciality | Clinic/Center |
| Location | 4902 S Cedar St, Lansing, Michigan |
| Authorized Official Name and Position | David Blankenship (PROGRAM DIRECTOR) |
| Authorized Official Contact | 5173947867 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Clinical Services Lansing 4902 S Cedar St Lansing MI 48910-5474 Ph: (517) 394-7867 | Victory Clinical Services Lansing 4902 S Cedar St Lansing MI 48910-5474 Ph: (517) 394-7867 |
| NPI Number | 1861627507 |
|---|---|
| Provider Enumeration Date | 05/26/2009 |
| Last Update Date | 03/22/2012 |
| Medicare PECOS PAC ID | 4082932074 |
|---|---|
| Medicare Enrollment ID | O20150423002525 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861627507 | NPI | - | NPPES |
| MI 10046M | Other | MI | OTP - SAMHSA # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 330330 (Michigan) | Secondary |
| 261QM2800X | Clinic/center - Methadone | 330330 (Michigan) | Primary |
| Provider Name | Denise M Warren |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1891725214 PECOS PAC ID: 0547239659 Enrollment ID: I20070822001100 |
| Provider Name | John H Evans |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1154509172 PECOS PAC ID: 9830273911 Enrollment ID: I20080227000829 |
| Provider Name | Lorenz P Kielhorn |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1891816427 PECOS PAC ID: 5496903825 Enrollment ID: I20120910000612 |
| Provider Name | Nicole M Minty |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1982940839 PECOS PAC ID: 0345569331 Enrollment ID: I20150423002566 |
| Provider Name | Tina M Sims |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1952676181 PECOS PAC ID: 2264751650 Enrollment ID: I20150506002497 |
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