1497132872 NPI number — VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY

Table of content: (NPI 1497132872)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497132872 NPI number — VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
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:
1497132872
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 758997
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21275-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 N 12TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23298-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-628-6643
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
PULEO
Authorized Official First Name:
DOMINIC
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
804-828-1295

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  4846246 , 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)

  • Identifier: 8506744 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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