| Victory Healthcare Llc | |
|
1430 16th Ave Longview WA 98632-2901 | |
| (253) 331-2381 | |
| (253) 201-6070 |
| Full Name | Victory Healthcare Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 1430 16th Ave, Longview, Washington |
| Authorized Official Name and Position | Gerard Sebastian (OWNER) |
| Authorized Official Contact | 3045512496 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Healthcare Llc 1430 16th Ave Longview WA 98632-2901 Ph: (360) 857-0451 | Victory Healthcare Llc 1430 16th Ave Longview WA 98632-2901 Ph: (253) 331-2381 |
| NPI Number | 1467220871 |
|---|---|
| Provider Enumeration Date | 12/14/2023 |
| Last Update Date | 09/05/2024 |
| Medicare PECOS PAC ID | 9133665995 |
|---|---|
| Medicare Enrollment ID | O20240729002390 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467220871 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Gerard Victor A Sebastian |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1790090611 PECOS PAC ID: 8729220181 Enrollment ID: I20140828000768 |
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