Victory Orthotics & Prosthetics LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

VICTORY ORTHOTICS & PROSTHETICS LLC

Practice address

2333 Knob Creek Rd Ste 14
Johnson City, TN 37604

Phone

(423) 461-3320

NPI assigned

Sep 28, 2006

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

Title

Coo

Phone

(615) 864-8790

Specialties & licenses 1

Addresses

Other identifiers 3

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
  • Knoxville, TN
  • NPI 1437692548

  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
  • Knoxville, TN
  • NPI 1437692548
  NPD tax ID
• Victory Orthotics & Prosthetics LLC

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

Locations

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1538524800000",
    "number": "1457443624",
    "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": "615-550-8774",
            "fax_number": "156-454-5352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 KNOB CREEK RD STE 14",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "37604",
            "telephone_number": "423-461-3320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY ORTHOTICS & PROSTHETICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2018-10-03",
        "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."
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9190601",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1454184",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTN",
            "identifier": "4017529",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stanley Eugene Vermillion, MD
• Regina Christine Vest, CNC
• Kristen Nichole Vicars, M.A.
• Shenoah Jade Vicars, OTR/L
• Tara Vick, MD
• Victory Vision, PLLC
• Meaghan Marie Viggiani, MA
• Michael Bryanne Villalba
• Jose Villanueva, PT
• Juan Carlos Simon Villegas Gomez, ATC

• Prosthetic/Orthotic Supplier in Johnson City, TN
• Providers in Johnson City, 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 Oct 3, 2018; 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.