NPIMap

Organization Active NPI

Victory Distributors, LLC

  • Durable Medical Equipment & Medical Supplies
  • Concord, NH
National Provider Identifier
1053544841
Registry record updated Nov 18, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
0398-P Issued in NH
Legal business name
VICTORY DISTRIBUTORS, LLC
Practice address
73 Fort Eddy Rd
Concord, NH 03301-7405
Phone
(603) 228-2121
Fax
(603) 223-9702
NPI assigned
Aug 27, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Elwen Eaton
Title
Pharmacy Insurance Specialist
Phone
(207) 885-7454

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 0398-P NH Primary

Addresses

Primary practice location

73 Fort Eddy Rd
Concord, NH 03301-7405

Mailing address

PO Box 1000
Ms3000
Portland, ME 04104-5005
Phone (207) 885-7454

Other identifiers 2

IdentifierTypeStateIssuer
3061176OtherNCPDP PROVIDER NUMBER
30707670MedicaidNH

Other names 1

  • Hannaford Food & Drug #8329 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100930056410 NH DME Supplier - PharmacyDME Supplier - Grocery Store 3476764911 Practice locations: Concord, NH
O20110125000906 NH Part B Supplier - Mass Immunization (Roster Biller Only) 3476764911 6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manchester, NH; Nashua, NH; Derry, NH; Concord, NH; Bedford, NH

Other NPIs with the same Medicare PAC ID 15

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 15

Other NPIs on the same Medicare enrollment 6

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Victory Distributors Inc27 organizations share this tax ID, including this one

Other organizations with this tax ID 26

Organizations that report the same tax identification number in the National Provider Directory.

View all 26

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1251331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1416268800000",
    "number": "1053544841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1000",
            "address_2": "MS3000",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041045005",
            "telephone_number": "207-885-7454",
            "fax_number": "207-885-3121"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "73 FORT EDDY RD",
            "city": "CONCORD",
            "state": "NH",
            "postal_code": "033017405",
            "telephone_number": "603-228-2121",
            "fax_number": "603-223-9702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY DISTRIBUTORS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-27",
        "last_updated": "2014-11-18",
        "status": "A",
        "authorized_official_last_name": "EATON",
        "authorized_official_first_name": "ELWEN",
        "authorized_official_title_or_position": "PHARMACY INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "207-885-7454"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NH",
            "license": "0398-P",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP PROVIDER NUMBER",
            "identifier": "3061176",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30707670",
            "state": "NH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hannaford Food & Drug #8329",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Concord, NH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.