Victory Orthotics & Prosthetics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

License

205596 Issued in TN

Legal business name

VICTORY ORTHOTICS & PROSTHETICS LLC

Practice address

9051 Executive Park Dr Ste 100
Knoxville, TN 37923-4651

Phone

(865) 249-8852

Fax

(865) 249-8674

NPI assigned

Nov 21, 2016

Last updated

Aug 13, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Brad Gardner, CPO

Title

Coo

Phone

(615) 864-8790

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

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

• Victory Orthotics & Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Johnson City, TN
  • NPI 1457443624

  9537371406

  Same PAC ID
• Victory Orthotics & Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Kingsport, TN
  • NPI 1891935763

  9537371406

  Same PAC ID

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Victory Orthotics Prosthetics LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Victory Orthotics & Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Johnson City, TN
  • NPI 1457443624
  NPD tax ID
• Victory Orthotics & Prosthetics LLC

  • Prosthetic/Orthotic Supplier
  • Kingsport, TN
  • NPI 1891935763
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Christian Zach Smith, CPO

  • Prosthetist
  • Johnson City, TN
  • NPI 1295233369

  Orthotist

  NPD (past)

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

{
    "created_epoch": "1479686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597276800000",
    "number": "1437692548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 WOODMONT BLVD STE 120",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372055249",
            "telephone_number": "615-864-8790",
            "fax_number": "615-454-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9051 EXECUTIVE PARK DR STE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234651",
            "telephone_number": "865-249-8852",
            "fax_number": "865-249-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY ORTHOTICS & PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-21",
        "last_updated": "2020-08-13",
        "certification_date": "2020-08-13",
        "status": "A",
        "authorized_official_last_name": "GARDNER",
        "authorized_official_first_name": "BRAD",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "615-864-8790",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "TN",
            "license": "205596",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George Wilson Vick II, M.D.
• Marvin Haber Vickers Jr., M.D.
• Daniel Vickery, AGCNS-BC
• Victor Hubbell Williams LLC (Knoxville Dental Center)
• Victor Hubbell Williams PLLC (Morristown Dentistry)
• Victory Treatment Program, LLC (Maltman Medical Center)
• Danielle Everett Videla, MS
• Ariel Vidlund
• Roger Gordon Vieth, MD
• View Associates (Comlementary Health Strategies)

• Prosthetic/Orthotic Supplier in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Prosthetic/Orthotic Supplier in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.