1124310446 NPI number — SOUTHERN DOMINION HEALTH SYSTEM, INC.

Table of content: (NPI 1124310446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124310446 NPI number — SOUTHERN DOMINION HEALTH SYSTEM, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHERN DOMINION HEALTH SYSTEM, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124310446
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 70
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23974-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-696-2165
Provider Business Mailing Address Fax Number:
434-696-1557

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13855 COURTHOUSE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DINWIDDIE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23841
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-469-3731
Provider Business Practice Location Address Fax Number:
804-469-5307
Provider Enumeration Date:
05/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SEAMANS
Authorized Official First Name:
JILL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
434-696-2165

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0400X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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