SOUTHERN DOMINION HEALTH SYSTEM, INC. (NPI# 1104069996) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104069996 |
| Entity Type | Organization |
| Organization Name | SOUTHERN DOMINION HEALTH SYSTEM, INC. |
| Other Organization Name | SDHS COUNSELING & BEHAVIORAL SERVICES |
| Practice Address |
1685 K-v Road Victoria VA 23974 |
| Mailing Address |
Po Box 70 Victoria VA 23974-0070 |
| Practice Telephone | 4346962319 |
| Practice Fax Number | 4346962326 |
| Mailing Telephone | 4346962165 |
| Mailing Fax Number | 4346961557 |
| Enumeration Date | 2009-04-09 |
| Last Update Date | 2015-11-25 |
| Authorized Official Name | MRS. JILL W. SEAMANS (CFO) |
| Authorized Official Telephone | 4346962165 |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHERN DOMINION HEALTH SYSTEM, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
Ambulatory Health Care Facilities | ||
| N | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
VA | Ambulatory Health Care Facilities | |
| N | 261QM0801X |
Clinic/Center Specialization: Mental Health (Including Community Mental Health Center) |
VA | Ambulatory Health Care Facilities | |
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| SDHS Counseling & Behavioral Services | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811256787 | Southern Dominion Health System, Inc. | Clinic/Center | 8830 Virginia Street, Amelia, VA 23002 | 2012-05-11 |
| 1124310446 | Southern Dominion Health System, Inc. | Clinic/Center | 13855 Courthouse Road, Dinwiddie, VA 23841 | 2011-05-04 |
| 1396995940 | Southern Dominion Health System, Inc. | Clinic/Center | 1685 K-v Road, Victoria, VA 23974 | 2008-09-19 |
| 1700099512 | Southern Dominion Health System, Inc. | Clinic/Center | 8920 Otterburn Rd, Amelia Court House, VA 23002-4854 | 2007-05-08 |
| 1497969091 | Southern Dominion Health System, Inc. | Clinic/Center | 1508 K-v Road, Victoria, VA 23974 | 2007-05-10 |
| 1487867206 | Southern Dominion Health System, Inc. | Clinic/Center | 13855 Courthouse Rd, Dinwiddie, VA 23841-2254 | 2007-05-08 |
| 1982817706 | Southern Dominion Health System, Inc. | Clinic/Center | 510 N Main St, Emporia, VA 23847-1236 | 2007-05-08 |
| 1295706588 | Southern Dominion Health System, Inc. | Clinic/Center | 1508 K V Rd, Victoria, VA 23974-2624 | 2006-01-27 |
| Street Address |
1685 K-V ROAD |
| City | VICTORIA |
| State | VA |
| Zip Code | 23974 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396995940 | Southern Dominion Health System, Inc. | Clinic/Center | 1685 K-v Road, Victoria, VA 23974 | 2008-09-19 |
| 1164966016 | Ashley Pollard | Dentist | 1685 K-v Road, Victoria, VA 23974 | 2016-12-12 |
| 1629403209 | Shannon Rakes | Social Worker | 1685 K-v Road, Victoria, VA 23974 | 2013-09-13 |
| 1467733253 | Aba Edzieba Mills-robertson | Dentist | 1685 K-v Road, Victoria, VA 23974 | 2011-09-07 |
| 1871735043 | Scott O. Davis | Social Worker | 1685 K-v Road, Victoria, VA 23974 | 2009-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174060594 | Elizabeth White Lipp | Behavioral Analyst | 2503 Nottoway Blvd., Victoria, VA 23974 | 2017-01-24 |
| 1902160849 | Daniel Lee Messerschmidt | Dentist | 690 Falls Rd, Victorira, VA 23974 | 2012-06-26 |
| 1902048424 | Family Preservation Services, Inc | Community/Behavioral Health | 3357 Nutbrush Road, Victoria, VA 23974 | 2009-03-30 |
| 1518118686 | Family Preservation Services, Inc | Community/Behavioral Health | 131 Kv Road, Victoria, VA 23974 | 2008-10-07 |
| 1053456087 | Victoria Drug Company | Pharmacy | 1821 Main Street, Victoria, VA 23974 | 2007-02-20 |
| 1821068024 | Troy West Pulliam | Physician Assistant | 1508 Kv Road, Victoria, VA 23974 | 2006-01-23 |
| 1083619563 | Jacquelin S Daniel | Nurse Practitioner | 1508 K-v Road, Victoria, VA 23974 | 2005-06-20 |
| 1992082796 | Mary K. St. Germain | Nurse Practitioner | 1508 K-v Road, Victoria, VA 23974 | 2011-11-08 |
| 1427293778 | Kuriakose V. Thekkethala | Family Medicine | 1508 K-v Road, Victoria, VA 23974 | 2008-12-15 |
| 1730339664 | John Alfred Holland Jr. | Family Medicine | 1508 K-v Road, Victoria, VA 23974 | 2008-09-29 |
| Find all providers in zip 23974 | ||||
| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548636665 | First Care Clinic, Inc. | Clinic/Center | 208 Marc Wagner Dr, Victoria, KS 67671-9589 | 2015-08-12 |
| 1396995940 | Southern Dominion Health System, Inc. | Clinic/Center | 1685 K-v Road, Victoria, VA 23974 | 2008-09-19 |
| 1467630731 | Southern Dominion Health System Inc | Clinic/Center | 1508 K V Road, Victoria, VA 23974-0070 | 2008-02-08 |
| 1558611475 | Community Health Centers of South Central Texas Inc | Clinic/Center | 4206 Retama Cir, Victoria, TX 77901-2765 | 2012-09-18 |
| 1497969091 | Southern Dominion Health System, Inc. | Clinic/Center | 1508 K-v Road, Victoria, VA 23974 | 2007-05-10 |
| 1295706588 | Southern Dominion Health System, Inc. | Clinic/Center | 1508 K V Rd, Victoria, VA 23974-2624 | 2006-01-27 |
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| 1689122186 | Monroe County Health Center Board of Trustees | Clinic/Center | 25239 Craigs Creek Rd, New Castle, VA 24127-6223 | 2016-09-14 |
| 1962950584 | Vernon J Harris East End Community Health Center | Clinic/Center | 1800 Lynhaven Ave, Richmond, VA 23224-7734 | 2016-09-12 |
| Find all providers with the same taxonomy | ||||
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| 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.