Organization
VICTORY MEDICAL SUPPLY, LLC
Active
Organization
VICTORY MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NATHAN T JOHNS (PRESIDENT)
(801) 770-0520
Entity
Organization
Contact information
Practice address
140 N 100 E, AMERICAN FORK, UT 84003-1735
(801) 770-0520
(801) 770-0922
Mailing address
13894 S BANGERTER PKWY STE 200, DRAPER, UT 84020-5320
(801) 770-0520
(801) 770-0922
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
626888500
DOL PROVIDER #
—
Enumeration date
05/05/2020
Last updated
05/05/2020
Update your record
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