Victory Medical Supply

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

VICTORY MEDICAL SUPPLY

Practice address

29350 Southfield Rd
Ste 121
Southfield, MI 48076-2053

Phone

(248) 552-8533

Fax

(248) 552-7281

NPI assigned

Aug 13, 2006

Organization subpart

No

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

Authorized official

Name

Rose Idiong

Title

Owner/Manager

Phone

(248) 552-8533

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1155427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528070976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29350 SOUTHFIELD RD",
            "address_2": "STE 121",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762053",
            "telephone_number": "248-552-8533",
            "fax_number": "248-552-7281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29350 SOUTHFIELD RD",
            "address_2": "STE 121",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480762053",
            "telephone_number": "248-552-8533",
            "fax_number": "248-552-7281"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VICTORY MEDICAL SUPPLY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "IDIONG",
        "authorized_official_first_name": "ROSE",
        "authorized_official_title_or_position": "OWNER/MANAGER",
        "authorized_official_telephone_number": "248-552-8533"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4509852",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Southfield, MI
• Providers in Southfield, MI by specialty
• Durable Medical Equipment & Medical Supplies in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.