# VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Medicaid - Nurse Practitioners
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871640359
- **Authorized official:** DOMINIC J PULEO (CFO)
- **Authorized official phone:** (804) 828-1295

## Contact information

- **Practice address:** 1250 E MARSHALL ST, RICHMOND, VA 23298-5051
- **Practice address phone:** (804) 828-6315
- **Mailing address:** PO BOX 758997, BALTIMORE, MD 21275-0001

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 282N00000X | General Acute Care Hospital | H1875 | VA | Yes |

## Other

- **Enumeration date:** 01/05/2007
- **Last updated:** 08/22/2020