| Victory Clinic Llc | |
|
715 Southwind Dr Junction City KS 66441-9021 | |
| (785) 209-3779 | |
| (785) 209-3780 |
| Full Name | Victory Clinic Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 715 Southwind Dr, Junction City, Kansas |
| Authorized Official Name and Position | Kristie Michelle Clark (MEMBER/OWNER) |
| Authorized Official Contact | 8176919968 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Clinic Llc 717 Kansa Ave Junction City KS 66441-8812 Ph: (785) 209-3779 | Victory Clinic Llc 715 Southwind Dr Junction City KS 66441-9021 Ph: (785) 209-3779 |
| NPI Number | 1104540079 |
|---|---|
| Provider Enumeration Date | 10/03/2022 |
| Last Update Date | 11/05/2022 |
| Medicare PECOS PAC ID | 8729459607 |
|---|---|
| Medicare Enrollment ID | O20230201001812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104540079 | NPI | - | NPPES |
| Provider Name | Robert T Clark |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1811903560 PECOS PAC ID: 2668574633 Enrollment ID: I20100610001087 |
| Provider Name | Kristie Michelle Clark |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1558473884 PECOS PAC ID: 5698776920 Enrollment ID: I20230825002670 |
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