Provider Demographics
NPI:1770530982
Name:VICTORY SPRINGS, INC
Entity type:Organization
Organization Name:VICTORY SPRINGS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KALU
Authorized Official - Middle Name:A
Authorized Official - Last Name:UMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-526-1490
Mailing Address - Street 1:210 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-1230
Mailing Address - Country:US
Mailing Address - Phone:410-526-1490
Mailing Address - Fax:410-526-9363
Practice Address - Street 1:210 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-1230
Practice Address - Country:US
Practice Address - Phone:410-526-1490
Practice Address - Fax:410-526-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0059107207RG0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD211400300Medicaid
MD850LOtherMEDICARE
MDG988OtherBC/BS FEDERAL PROGRAM
MDLRV2VIOtherBLUE CROSS
MD1234OtherRAILROAD MEDICARE
MDG988OtherBC/BS FEDERAL PROGRAM
MD211400300Medicaid