| Victory Springs, Inc | |
|
210 Business Center Dr Reisterstown MD 21136-1230 | |
| (410) 526-1490 | |
| (410) 526-9363 |
| Full Name | Victory Springs, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 210 Business Center Dr, Reisterstown, Maryland |
| Authorized Official Name and Position | Kalu A Uma (PRESIDENT) |
| Authorized Official Contact | 4105261490 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victory Springs, Inc 210 Business Center Dr Reisterstown MD 21136-1230 Ph: (410) 526-1490 | Victory Springs, Inc 210 Business Center Dr Reisterstown MD 21136-1230 Ph: (410) 526-1490 |
| NPI Number | 1770530982 |
|---|---|
| Provider Enumeration Date | 05/31/2006 |
| Last Update Date | 09/11/2009 |
| Medicare PECOS PAC ID | 2668489543 |
|---|---|
| Medicare Enrollment ID | O20060317000279 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770530982 | NPI | - | NPPES |
| 211400300 | Medicaid | MD | |
| 850L | Other | MD | MEDICARE |
| G988 | Other | MD | BC/BS FEDERAL PROGRAM |
| LRV2VI | Other | MD | BLUE CROSS |
| 1234 | Other | MD | RAILROAD MEDICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D0059107 (Maryland) | Primary |
| 207RG0300X | Internal Medicine - Geriatric Medicine | D0059107 (Maryland) | Secondary |
| Provider Name | Chiemeka A Uma |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1821057654 PECOS PAC ID: 4082674171 Enrollment ID: I20041013000674 |
| Provider Name | Vida Kwofie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972970705 PECOS PAC ID: 0840500104 Enrollment ID: I20151117001573 |
| Provider Name | Adetimbo Adediran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1679922298 PECOS PAC ID: 4082902937 Enrollment ID: I20161011000053 |
| Provider Name | Mary L Turner |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568975654 PECOS PAC ID: 1456619402 Enrollment ID: I20171220000862 |
| Provider Name | Maureen I Edozie |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881117190 PECOS PAC ID: 9931461399 Enrollment ID: I20180322001920 |
| Provider Name | Vivian N Uzoma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962041855 PECOS PAC ID: 9830525401 Enrollment ID: I20200130002725 |
| Provider Name | Bilikisu O Adekanbi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063030245 PECOS PAC ID: 1759799885 Enrollment ID: I20210409000590 |
| Provider Name | Beauty K Nwamoh |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013680248 PECOS PAC ID: 8123418233 Enrollment ID: I20211203002082 |
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