PETERSBURG HOSPITAL COMPANY LLC (NPI# 1164585576) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1164585576 |
| Entity Type | Organization |
| Organization Name | PETERSBURG HOSPITAL COMPANY LLC |
| Other Organization Name | SOUTHSIDE REGIONAL MEDICAL CENTER |
| Practice Address |
3335 South Crater Road Petersburg VA 23805 |
| Mailing Address |
Po Box 501128 St Louis MO 63150 |
| Practice Telephone | 8047655000 |
| Practice Fax Number | 8047655962 |
| Mailing Telephone | 8047655000 |
| Mailing Fax Number | 8047655962 |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2017-08-03 |
| Authorized Official Name | PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL) |
| Authorized Official Telephone | 6159254565 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 251S00000X | Community/Behavioral Health | Agencies |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | ANTHEM BCBS BEHAVIORAL | 442491 | 01 |
| Other Name | Type Code |
|---|---|
| Southside Regional Medical Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174596084 | Petersburg Hospital Company LLC | Clinic/Center | 3335 S Crater Rd, Petersburg, VA 23805-9214 | 2006-02-10 |
| 1336138155 | Petersburg Hospital Company LLC | Clinic/Center | 436 Clairmont Court, Suite 100, Colonial Heights, VA 23834 | 2005-10-14 |
| 1740303593 | Petersburg Hospital Company LLC | Clinical Medical Laboratory | 200 Medical Park Blvd, Petersburg, VA 23805 | 2007-04-09 |
| 1902942071 | Petersburg Hospital Company LLC | Clinic/Center | 436 Claremont Ct, Colonial Heights, VA 23834-1765 | 2007-01-29 |
| 1245393685 | Petersburg Hospital Company LLC | Clinic/Center | 3335 S Crater Rd, Petersburg, VA 23805-9214 | 2006-12-18 |
| 1013070325 | Petersburg Hospital Company LLC | Clinic/Center | 436 Clairmont Court, Colonial Heights, VA 23834 | 2006-12-18 |
| 1770556862 | Petersburg Hospital Company LLC | Skilled Nursing Facility | 200 Medical Park Blvd, Petersburg, VA 23805 | 2006-02-09 |
| 1437122645 | Petersburg Hospital Company LLC | Psychiatric Unit | 200 Medical Park Blvd, Petersburg, VA 23805 | 2006-02-08 |
| 1104899319 | Petersburg Hospital Company LLC | General Acute Care Hospital | 200 Medical Park Blvd, Petersburg, VA 23805 | 2006-02-08 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Petersburg Hospital Company LLC | 155 Franklin Rd Suite 400, Brentwood, Tennessee 37027 |
| Street Address |
3335 SOUTH CRATER ROAD |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 251S00000X |
| Grouping | Agencies |
| Classification | Community/Behavioral Health |
| A private or public agency usually under local government jurisdiction, responsible for assuring the delivery of community based mental health, mental retardation, substance abuse and/or behavioral health services to individuals with those disabilities. Services may range from companion care, respite, transportation, community integration, crisis intervention and stabilization, supported employment, day support, prevocational services, residential support, therapeutic and supportive consultation, environmental modifications, intensive in-home therapy and day treatment, in addition to traditional mental health and behavioral treatment. |
| Notes: Source: National Medicaid EDI HIPAA NPI Sub Work Group [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831720713 | Southeast Alaska Regional Health Consortium | Community/Behavioral Health | 202 2nd & Gjoa Street, Petersburg, AK 99833 | 2020-01-30 |
| 1881104891 | Family Preservation Services, Inc. | Community/Behavioral Health | 816 E Bank St, Petersburg, VA 23803-3406 | 2017-10-04 |
| 1003342445 | Commonwealth Day Support | Community/Behavioral Health | 500 S Sycamore St, Petersburg, VA 23803-5046 | 2017-05-04 |
| 1356899652 | Armos | Community/Behavioral Health | 43 Rives Rd Bsmt, Petersburg, VA 23805-9255 | 2016-09-14 |
| 1427403476 | First Step Service LLC | Community/Behavioral Health | 20 E Tabb St Ste 204, Petersburg, VA 23803-4560 | 2016-04-27 |
| 1932560927 | Heavenly Touch Counseling Service LLC. | Community/Behavioral Health | 1035 Gustavo Ln, Petersburg, VA 23805-2356 | 2016-03-17 |
| 1578972139 | Alternative Behavioral Concepts, LLC | Community/Behavioral Health | 441 Harding St, Petersburg, VA 23803-5019 | 2014-08-07 |
| 1780929364 | Centel Healthcare Inc | Community/Behavioral Health | 803 Hinton St, Suite 308, Petersburg, VA 23803-3028 | 2012-12-07 |
| 1760789200 | Extreme Counseling Solutions | Community/Behavioral Health | 811 Logan St, Petersburg, VA 23803-3329 | 2011-02-18 |
| 1861796039 | Envision One | Community/Behavioral Health | 15 Goodrich Ave, Petersburg, VA 23805-2119 | 2011-01-03 |
| Find all providers in PETERSBURG | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
Please comment or provide details below to improve the information on PETERSBURG HOSPITAL COMPANY LLC.
| 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.