Provider Demographics
NPI:1245375179
Name:VICTORY MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:VICTORY MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRISIDENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:U
Authorized Official - Last Name:ANADUMAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:773-783-8666
Mailing Address - Street 1:8156 S COTTAGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5104
Mailing Address - Country:US
Mailing Address - Phone:773-783-8666
Mailing Address - Fax:773-783-8664
Practice Address - Street 1:8156 S COTTAGE GROVE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5104
Practice Address - Country:US
Practice Address - Phone:773-783-8666
Practice Address - Fax:773-783-8664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203000788332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001636799OtherBC/BS
IL0001636799OtherBC/BS