Victory Healthcare LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

VICTORY HEALTHCARE LLC

Doing business as

Victory Diabetes and Primary Clinic

Practice address

1430 16TH Ave
Longview, WA 98632-2901

Phone

(253) 331-2381

Fax

(253) 201-6070

NPI assigned

Dec 14, 2023

Organization subpart

No

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

Authorized official

Name

Dr. Gerard Sebastian, MD

Title

Owner

Phone

(304) 551-2496

Specialties & licenses 1

Addresses

Other names 1

• Victory Diabetes and Primary Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gerard Victor Arceo Sebastian, MD

  • Family Medicine Physician
  • Battle Ground, WA
  • NPI 1790090611
  Medicare reassignment NPD
• Kessa Mystique Stephenson-Taylor, AA, BA

  • Mental Health Counselor
  • Longview, WA
  • NPI 1255833885
  NPD
• David Lee Moeglein, MSW, LICSW

  • Clinical Social Worker
  • Vancouver, WA
  • NPI 1245665025
  NPD (past)

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

{
    "created_epoch": "1702512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725494400000",
    "number": "1467220871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1430 16TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322901",
            "telephone_number": "360-857-0451",
            "fax_number": "360-857-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1430 16TH AVE",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322901",
            "telephone_number": "253-331-2381",
            "fax_number": "253-201-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-12-14",
        "last_updated": "2024-09-05",
        "certification_date": "2024-09-05",
        "status": "A",
        "authorized_official_last_name": "SEBASTIAN",
        "authorized_official_first_name": "GERARD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "304-551-2496",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Victory Diabetes and Primary Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Veronica Eldora Vargas, LPN
• Aaron C Varney, OT
• Elizabeth Verbrugge, PHARMD
• Sarah Vest, CCC-SLP
• Irma Vicentainer, BA, R-AAC
• Lizbeth Guadalupe Vigil
• Carrie Jean Vigoren, LMT
• Carol Villalobos
• Annette Pearl Ville, MD
• David A Vogel, OT

• Family Medicine Physician in Longview, WA
• Providers in Longview, WA by specialty
• Family Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2024; 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.