Organization
VICTORY HEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JOAN WEEMS RN (OWNER)
(580) 371-8500
Entity
Organization
Contact information
Practice address
714 E MAIN ST, TISHOMINGO, OK 73460-2350
(580) 371-8500
(580) 371-2282
Mailing address
705 W MAIN ST, TISHOMINGO, OK 73460-1734
(580) 371-2002
(580) 371-2058
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DC5163
RR MEDICARE
—
Enumeration date
05/02/2006
Last updated
04/20/2008
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