Organization
VICTORY DIALYSIS LLC
Active
Organization
VICTORY DIALYSIS LLC
Active
Other names
Aviation Blvd Dialysis
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T WEY (VP LICENSURE & CERTIFICATION)
(615) 341-6641
Entity
Organization
Contact information
Practice address
6934 AVIATION BLVD, STE K, GLEN BURNIE, MD 21061-2593
(410) 553-6951
(410) 766-0513
Mailing address
5200 VIRGINIA WAY, L&C DEPT, BRENTWOOD, TN 37027-7569
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
E2631
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0351575 00
—
DC
05
—
402823600
—
MD
Enumeration date
05/05/2011
Last updated
05/26/2026
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