VICTORY ORTHOTICS & PROSTHETICS LLC (NPI# 1891935763) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1891935763 |
| Entity Type | Organization |
| Organization Name | VICTORY ORTHOTICS & PROSTHETICS LLC |
| Practice Address |
2 Sheridan Sq Suite 100 Kingsport TN 37660 |
| Mailing Address |
2 Sheridan Sq Suite 100 Kingsport TN 37660-7399 |
| Practice Telephone | 4233783320 |
| Practice Fax Number | 4233783363 |
| Mailing Telephone | 4233783320 |
| Mailing Fax Number | 4233783363 |
| Enumeration Date | 2009-03-04 |
| Last Update Date | 2018-10-03 |
| Authorized Official Name | MR. BRAD GARDNER (COO) |
| Authorized Official Telephone | 6158648790 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | TN | Suppliers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TN | BCBST | 4017529 | 01 |
| TN | 1454184 | 05 | |
| VA | 9190601 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437692548 | Victory Orthotics & Prosthetics LLC | Prosthetic/Orthotic Supplier | 9051 Executive Park Dr Ste 100, Knoxville, TN 37923-4651 | 2016-11-21 |
| 1861664047 | Victory Orthotics & Prosthetics LLC | Prosthetic/Orthotic Supplier | 324 Steeles Rd, Bristol, TN 37620 | 2008-03-28 |
| 1457443624 | Victory Orthotics & Prosthetics LLC | Prosthetic/Orthotic Supplier | 2333 Knob Creek Rd Ste 14, Johnson City, TN 37604 | 2006-09-28 |
| Street Address |
2 SHERIDAN SQ SUITE 100 |
| City | KINGSPORT |
| State | TN |
| Zip Code | 37660 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033101126 | Kenneth Wayne Smith | Neurological Surgery | 2 Sheridan Sq, Suite 200, Kingsport, TN 37660-7399 | 2005-08-16 |
| 1609311349 | Melissa Hope Ford | Registered Nurse | 2 Sheridan Sq, Kingsport, TN 37660-7399 | 2017-01-05 |
| 1649656240 | Bonnie Henley | Nurse Practitioner | 2 Sheridan Sq, Ste 200, Kingsport, TN 37660-7399 | 2015-08-05 |
| 1699048066 | Elizabeth Michelle Crawford | Nurse Practitioner | 2 Sheridan Sq, Suite 200, Kingsport, TN 37660-7399 | 2012-02-16 |
| 1720097702 | Emile George Schmidt Jr. | Physical Therapist | 2 Sheridan Sq, Suite 200, Kingsport, TN 37660-7399 | 2006-08-07 |
| 1871502880 | Blue Ridge Neuroscience Center, P.C. | Specialist | 2 Sheridan Sq, Ste 200, Kingsport, TN 37660-7399 | 2006-08-07 |
| 1275525354 | Carla Renee Cheek | Nurse Practitioner | 2 Sheridan Sq, Suite 200, Kingsport, TN 37660-7399 | 2005-08-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750909891 | Nancy Gober | Pharmacist | Holston Valley Medical Center Inpatient Pharmacy, 130 W Ravine, Kingsport, TN 37660 | 2020-07-06 |
| 1700437621 | Tammy Denise Leblanc | Technician | 125 Lancer Rd, Kingsport, TN 37660 | 2019-09-23 |
| 1831743392 | Independent Physical Therapy | Occupational Therapist | 1704 E. Stone Dr. Ste 120, Kingsport, TN 37660 | 2019-08-01 |
| 1871095315 | Macie Anderson | Nurse Practitioner | 411 Clay St, Kingsport, TN 37660 | 2018-03-01 |
| 1053813527 | Pulitzer Orthodontics, LLC | Dentist | 1200 Pulitzer Place, Kingsport, TN 37660 | 2018-03-01 |
| 1174038749 | Sbh-kingsport | Psychiatric Hospital | 1025 Executive Park Blvd, Kingsport, TN 37660 | 2017-12-05 |
| 1548771447 | Sara B Ball | Registered Nurse | 111 W Stone Dr Ste 240, Kingsport, TN 37660 | 2017-10-18 |
| 1821525361 | Ashley Brook Weems | Nurse Practitioner | Six Sheridan Square Suite 100, Kingsport, TN 37660 | 2017-05-15 |
| 1639625643 | Stephanie H Garris | Nurse Practitioner | 117 W Sevier Ave Ste 120, Kingsport, TN 37660 | 2016-08-30 |
| 1073965679 | Teresa Anne Starke | Physician Assistant | 8 Sheridan Square, Suite 110, Kingsport, TN 37660 | 2016-07-07 |
| Find all providers in zip 37660 | ||||
| Taxonomy Code | 335E00000X |
| Grouping | Suppliers |
| Classification | Prosthetic/Orthotic Supplier |
| An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841761947 | Mac's Medicine Mart Dba Unique Boutique | Prosthetic/Orthotic Supplier | 1455 E Center St Ste 2b, Kingsport, TN 37664-2501 | 2018-12-16 |
| 1023368180 | Achieve Bracing | Prosthetic/Orthotic Supplier | 1732 N Eastman Rd Ste 1a, Kingsport, TN 37664-2376 | 2012-09-17 |
| 1154653830 | Southern Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 1567 N Eastman Rd Ste 4, Kingsport, TN 37664-2680 | 2010-02-05 |
| 1104012319 | Pro Balance LLC | Prosthetic/Orthotic Supplier | 2408 Fort Henry Drive, Kingsport, TN 37664 | 2007-09-20 |
| 1740373661 | Jason D Joyce | Prosthetic/Orthotic Supplier | 1567 N Eastman Rd, Suite 4, Kingsport, TN 37664-2683 | 2006-10-02 |
| 1528167509 | Custom Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 1567 North Eastman Rd, Ste 4, Kingsport, TN 37664-2680 | 2006-09-22 |
| 1982670964 | Appalachian Prosthetic & Orthotic Services, Inc | Prosthetic/Orthotic Supplier | 3551 E Stone Dr, Kingsport, TN 37660-7115 | 2006-02-28 |
| 1992257745 | Excel Prosthetics & Orthotics, Inc | Prosthetic/Orthotic Supplier | 121 E Ravine Rd, Suite 400, Kingsport, TN 37660 | 2016-10-27 |
| 1437563665 | Bristol Orthotics & Prosthetics, Inc | Prosthetic/Orthotic Supplier | 921 Broad St, Kingsport, TN 37660-3801 | 2014-06-16 |
| 1518238278 | Finer Things for Her | Prosthetic/Orthotic Supplier | 1880 N Eastman Rd, Suite 230, Kingsport, TN 37664-2312 | 2012-01-25 |
| Find all providers in KINGSPORT | ||||
Please comment or provide details below to improve the information on VICTORY ORTHOTICS & PROSTHETICS LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.