NPIMap

Organization Active NPI

Petersburg Hospital Company LLC

  • Community/Behavioral Health Agency
  • Petersburg, VA
National Provider Identifier
1164585576
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
Legal business name
PETERSBURG HOSPITAL COMPANY LLC
Practice address
3335 South Crater Road
Petersburg, VA 23805
Phone
(804) 765-5000
Fax
(804) 765-5962
NPI assigned
Dec 18, 2006
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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X Primary

Addresses

Primary practice location

3335 South Crater Road
Petersburg, VA 23805

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
442491OtherVAANTHEM BCBS BEHAVIORAL

Other names 1

  • Southside Regional Medical Center Doing business as

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.

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": "1164585576",
    "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": "3335 SOUTH CRATER ROAD",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "23805",
            "telephone_number": "804-765-5000",
            "fax_number": "804-765-5962"
        }
    ],
    "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": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BCBS BEHAVIORAL",
            "identifier": "442491",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southside Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petersburg, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.