Victory Medical Supply Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

203000788 Issued in IL

Legal business name

VICTORY MEDICAL SUPPLY INC

Practice address

8156 S Cottage Grove Ave
Chicago, IL 60619-5104

Phone

(773) 783-8666

Fax

(773) 783-8664

NPI assigned

Feb 20, 2007

Organization subpart

No

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

Authorized official

Name

Miss Vicky U Anadumaka

Title

Prisident

Phone

(773) 783-8666

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Locations

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

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205193600000",
    "number": "1245375179",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8156 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606195104",
            "telephone_number": "773-783-8666",
            "fax_number": "773-783-8664"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8156 S COTTAGE GROVE AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606195104",
            "telephone_number": "773-783-8666",
            "fax_number": "773-783-8664"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY MEDICAL SUPPLY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-20",
        "last_updated": "2008-03-11",
        "status": "A",
        "authorized_official_last_name": "ANADUMAKA",
        "authorized_official_first_name": "VICKY",
        "authorized_official_middle_name": "U",
        "authorized_official_title_or_position": "PRISIDENT",
        "authorized_official_telephone_number": "773-783-8666",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203000788",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "0001636799",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Victory RX, Inc
• Vida Health Wellness, PLLC
• Vida Medical Centers PLLC

• Durable Medical Equipment & Medical Supplies in Chicago, IL
• Providers in Chicago, IL by specialty
• Durable Medical Equipment & Medical Supplies in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.