NPIMap

Organization Active NPI

Petersburg Hospital Company LLC

Doing business as Southside Regional Medical Center

  • Clinical Medical Laboratory
  • Colonial Heights, VA
National Provider Identifier
1013070325
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
PETERSBURG HOSPITAL COMPANY LLC
Doing business as
Southside Regional Medical Center
Practice address
436 Clairmont Court
Colonial Heights, VA 23834
Phone
(804) 862-5000
NPI assigned
Dec 18, 2006
Last updated
Aug 3, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Paula M Lalor
Title
Director/Delegated Official
Phone
(615) 925-4565

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

436 Clairmont Court
Colonial Heights, VA 23834

Mailing address

PO Box 501128
St Louis, MO 63150
Phone (804) 765-5000

Other identifiers 1

IdentifierTypeStateIssuer
138348OtherVAANTHEM BCBS PT LAB RADIO

Other names 1

  • Southside Regional Medical Center Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2000182Southside Regional Med Ctr Outpatient Ctr436 Clairmont Court - Suite 101, Colonial Heights, VA 23834Certificate of waiverNov 22, 2027

National Provider Directory

National Provider Directory
Tax ID family
Petersburg Hospital Company LLC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

436 Clairmont Ct
Colonial Hgts, VA 23834
Phone (804) 526-2121

436 Clairmont Ct
Ste 6
Colonial Hgts, VA 23834
Phone (804) 526-2121

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1013070325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 501128",
            "city": "ST LOUIS",
            "state": "MO",
            "postal_code": "63150",
            "telephone_number": "804-765-5000",
            "fax_number": "804-765-5962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "436 CLAIRMONT COURT",
            "city": "COLONIAL HEIGHTS",
            "state": "VA",
            "postal_code": "23834",
            "telephone_number": "804-862-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSBURG HOSPITAL COMPANY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2017-08-03",
        "status": "A",
        "authorized_official_last_name": "LALOR",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DIRECTOR/DELEGATED OFFICIAL",
        "authorized_official_telephone_number": "615-925-4565"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS PT LAB RADIO",
            "identifier": "138348",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Colonial Heights, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.