| Victory Clinical Services III LLC | |
|
3300 Lansing Ave Jackson MI 49202-1621 | |
| (517) 784-2929 | |
| Not Available |
| Full Name | Victory Clinical Services III LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 3300 Lansing Ave, Jackson, Michigan |
| Authorized Official Name and Position | David Blankenship (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 5177842929 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Clinical Services III LLC 3300 Lansing Ave Jackson MI 49202-1621 Ph: (517) 784-2929 | Victory Clinical Services III LLC 3300 Lansing Ave Jackson MI 49202-1621 Ph: (517) 784-2929 |
| NPI Number | 1629101829 |
|---|---|
| Provider Enumeration Date | 03/14/2007 |
| Last Update Date | 08/07/2026 |
| Certification Date | 08/07/2026 |
| Medicare PECOS PAC ID | 0244487825 |
|---|---|
| Medicare Enrollment ID | O20200122000109 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629101829 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | 380098 (Michigan) | Primary |
| 261QM2800X | Clinic/center - Methadone | () | Secondary |
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