VICTORY CLINICAL SERVICES IV LLC NPI 1922249440

NPI Information

  • NPI: 1922249440
  • Provider Name: VICTORY CLINICAL SERVICES IV, LLC
  • Classification: Clinic/Center - 261QM2800X
  • Specialization: Methadone
  • Entity Type: Organization
  • Other Name: VICTORY CLINIC IV
  • Address: 508 SHATTUCK RD
    SAGINAW, MI
    ZIP 48604
  • Phone: (989) 754-7867

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NPI Details

VICTORY CLINICAL SERVICES IV, LLC is a methadone clinic center in Saginaw, MI. The provider is an entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with drug addiction. VICTORY CLINICAL SERVICES IV, LLC NPI is 1922249440. The provider is registered as an organization entity type.
The provider Other Name Is Victory Clinic Iv.

The provider's business location address is:

508 SHATTUCK RD
SAGINAW, MI
ZIP 48604-329
Phone: (989) 754-7867

The provider's authorized official is David Blankenship .
The authorized official title is Program Director and has the following contact phone number (989) 754-7867.

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Medication assisted treatment, methadone; weekly bundle including dispensing and/or administration, substance use counseling, individual and group therapy, and toxicology testing, if performed (provision of the services by a medicare-enrolled opioid treatm (HCPCS:G2067)
  • Take-home supply of methadone; up to 7 additional day supply (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for primary procedure (HCPCS:G2078)
  • Periodic assessment; assessing periodically by qualified personnel to determine the most appropriate combination of services and treatment (provision of the services by a medicare-enrolled opioid treatment program); list separately in addition to code for (HCPCS:G2077)

The enumeration date for this NPI number is 3/12/2009 and was last updated on 3/12/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QR0405XClinic/CenterRehabilitation, Substance Use Disorder730208MICHIGANNo
2261QM2800XClinic/CenterMethadone730208MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1MI10200MOTHERMICHIGANOTP-SAMHSA ID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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