| Victory Health Clinic Llc | |
|
714 E Main St Tishomingo OK 73460-2350 | |
| (580) 371-8500 | |
| (580) 371-2282 |
| Full Name | Victory Health Clinic Llc |
|---|---|
| Speciality | Clinic/center |
| Location | 714 E Main St, Tishomingo, Oklahoma |
| Authorized Official Name and Position | Joan Weems (OWNER) |
| Authorized Official Contact | 5803718500 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Health Clinic Llc 705 W Main St Tishomingo OK 73460-1734 Ph: (580) 371-2002 | Victory Health Clinic Llc 714 E Main St Tishomingo OK 73460-2350 Ph: (580) 371-8500 |
| NPI Number | 1912965898 |
|---|---|
| Provider Enumeration Date | 05/02/2006 |
| Last Update Date | 04/20/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912965898 | NPI | - | NPPES |
| DC5163 | Other | RR MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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