NPIMap

Organization Active NPI

Petersburg Hospital Company LLC

Doing business as Southside Regional Medical Center

  • Clinical Medical Laboratory
  • Petersburg, VA
National Provider Identifier
1740303593
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
H1905 Issued in VA
Legal business name
PETERSBURG HOSPITAL COMPANY LLC
Doing business as
Southside Regional Medical Center
Practice address
200 Medical Park Blvd
Petersburg, VA 23805
Phone
(804) 765-5000
Fax
(804) 765-5962
NPI assigned
Apr 9, 2007
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
Clinical Medical Laboratory 291U00000X H1905 VA Primary

Addresses

Primary practice location

200 Medical Park Blvd
Petersburg, VA 23805

Mailing address

PO Box 501128
Saint Louis, MO 63150-0001
Phone (804) 862-5000

Other identifiers 1

IdentifierTypeStateIssuer
142853OtherVABL CR IND LAB PROV NUMBER

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
49D0230764Southside Regional Medical Center200 Medical Park Boulevard, Petersburg, VA 23805AccreditationFeb 8, 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.

NPI Registry JSON

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

{
    "created_epoch": "1176076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1501718400000",
    "number": "1740303593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 501128",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631500001",
            "telephone_number": "804-862-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 MEDICAL PARK BLVD",
            "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": "2007-04-09",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "H1905",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BL CR IND LAB PROV NUMBER",
            "identifier": "142853",
            "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.
  • 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.