Organization
PETERSBURG HOSPITAL COMPANY LLC
Active
Other names
Southside Regional Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL)
(615) 925-4565
Entity
Organization
Contact information
Practice address
436 CLAIRMONT COURT, COLONIAL HEIGHTS, VA 23834
(804) 862-5000
Mailing address
PO BOX 501128, ST LOUIS, MO 63150
(804) 765-5000
(804) 765-5962
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
—
—
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
138348
ANTHEM BCBS PT LAB RADIO
VA
Enumeration date
12/18/2006
Last updated
08/03/2017
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