Bon Secours Mercy Health Emporia LLC
Organization Active NPI Psychiatric Hospital Unit · Emporia, VA
NPI 1467097535 · NPPES record last updated Nov 23, 2020
Key facts
- NPI
- 1467097535
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatric Hospital Unit 273R00000X
- Legal business name
- BON SECOURS MERCY HEALTH EMPORIA LLC
- Practice address
- 727 N Main St
Emporia, VA 23847-1274 - Phone
- (434) 348-4400
- NPI assigned
- Nov 13, 2019
- Organization subpart
- No
Authorized official
- Name
- Kimberly M Ralston
- Title
- System Director
- Phone
- (419) 996-5119
Owners & managing parties with NPI records 1
-
Lang Robertson Liebman, M.D.
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 2
Related certifications (CCN) 1
Facilities with the same owner 97
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Hospital certification: CCN 49S097
- Legal name
- BON SECOURS MERCY HEALTH EMPORIA LLC
- Doing business as
- BON SECOURS SOUTHERN VIRGINIA MEDICAL CENTER
- Organization structure
- LLC · Non-profit
- Enrollment address
- 727 N Main St
Emporia, VA 23847-1274 - Hospital subgroups
- Psychiatric unit
All disclosed owners & managing parties 19
| Name | Role | Since | Share |
|---|---|---|---|
| Jeffrey Szyperski |
Corporate Director |
Jan 1, 2024 | |
| Rebecca W McDonough |
Corporate Director |
Jan 1, 2025 | |
| Paula P Pando |
Corporate Director |
Jan 1, 2025 | |
| Robert Ukrop |
Corporate Director |
Jan 1, 2025 | |
| Wael N Haidar |
Corporate Director |
Jan 1, 2023 | |
| Osman Parvaiz |
Corporate Director |
Jan 1, 2025 | |
| Lang R Liebman |
Corporate Director |
Jan 1, 2022 | |
| James Carter |
Corporate Director |
Jan 1, 2025 | |
| Brian Yanofchick |
Corporate Director |
Jan 1, 2020 | |
| Bon Secours Mercy Health Inc |
5% Or Greater Indirect Ownership Interest | Jan 1, 2020 | 100% |
| John Starcher |
Operational/Managerial Control |
Jan 1, 2020 | |
| Regina J Elbert |
Corporate Director |
Jan 1, 2022 | |
| Michael Quinones |
Corporate Director |
Jan 1, 2023 | |
| William Kusnierz |
Corporate Officer |
Sep 8, 2020 | |
| Corporate Director |
Sep 8, 2020 | ||
| Mary Shimo |
Corporate Director |
Apr 22, 2022 | |
| Bon Secours Richmond LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2020 | 100% |
| Michael John Lutes |
Corporate Director |
Oct 1, 2022 | |
| Devon Henry |
Corporate Director |
Jan 1, 2024 | |
| Kimberly M Ralston |
W-2 Managing Employee |
Jan 1, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200103002278 | VA | Part a Provider - Hospital | 9537593256 | Practice locations: Emporia, VA |
National Provider Directory
- Tax ID family
- Bon Secours Mercy Health Emporia LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric Hospital Unit | 273R00000X | Yes |
Addresses
Primary practice location
727 N Main St
Emporia, VA 23847-1274
Mailing address
PO Box 639858
Cincinnati, OH 45263-9858
Other names
- BON SECOURS - SOUTHERN VIRGINIA REGINAL MEDICAL CENTER
- SOUTHERN VIRGINIA REGIONAL MEDICAL CENTER
Other providers in Emporia, VA
- Kathryn Marie Bennett
- Adel G Bishai
- Bon Secours Medical Group Hampton Roads Specialty Care LLC
- Bon Secours Mercy Health Emporia LLC
- Bon Secours Mercy Health Emporia LLC
- Audrey O Brown
- Gloria Denisha Brown
- Kelly Vargo Byers
- Lisa Capps
- Care Advantage, Inc.
All providers in Emporia, VA · Psychiatric Hospital Unit in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 23, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.