Organization · NPI-2

Petersburg Hospital Company LLC

Clinical Medical Laboratory · Petersburg, VA

NPI number1740303593

StatusActive

Last updated in NPPESAug 3, 2017

Details

NPI: 1740303593
Entity type: Organization (NPI-2)
Legal business name: Petersburg Hospital Company LLC
Organization subpart: No
Enumeration date: Apr 9, 2007
Last updated: Aug 3, 2017

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
291U00000X	Clinical Medical Laboratory	H1905	VA	Yes

Other names

Southside Regional Medical Center (Doing Business As)

Practice location

200 Medical Park Blvd
Petersburg, VA 23805

Phone 804-765-5000 · Fax 804-765-5962

Mailing address

Po Box 501128
Saint Louis, MO 63150-0001

Phone 804-862-5000

Authorized official

Paula M Lalor
Director/Delegated Official
6159254565

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