NPIMap

Organization Active NPI

Commonwealth of Virginia Southside VA Training Center

  • Hospitalist Physician
  • Petersburg, VA
National Provider Identifier
1639232408
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
Legal business name
COMMONWEALTH OF VIRGINIA SOUTHSIDE VA TRAINING CENTER
Practice address
26317 W. Washington Street
Petersburg, VA 23803-0000
Phone
(804) 524-7537
NPI assigned
Dec 19, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
John Holland Jr., M.D.
Title
Facility Director
Phone
(804) 524-7537

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X Primary

Addresses

Primary practice location

26317 W. Washington Street
Petersburg, VA 23803-0000

Mailing address

PO Box 4030
Petersburg, VA 23803-0030

Other identifiers 1

IdentifierTypeStateIssuer
CO2260OtherVAPHYSICIAN GROUP NUMBER

National Provider Directory

National Provider Directory

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": "1166486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1639232408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4030",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238030030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26317 W. WASHINGTON STREET",
            "city": "PETERSBURG",
            "state": "VA",
            "postal_code": "238030000",
            "telephone_number": "804-524-7537"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF VIRGINIA SOUTHSIDE VA TRAINING CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "FACILITY DIRECTOR",
        "authorized_official_telephone_number": "804-524-7537",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN GROUP NUMBER",
            "identifier": "CO2260",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 22, 2020; 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.