Organization
PETERSBURG HOSPITAL COMPANY LLC
Active
Other names
Southside Regional Medical Center - Renal Services
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA M LALOR (DIRECTOR/DELEGATED OFFICIAL)
(615) 925-4565
Entity
Organization
Contact information
Practice address
3335 S CRATER RD, PETERSBURG, VA 23805-9214
(804) 765-5261
(804) 765-5869
Mailing address
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805-9274
(804) 765-5261
(804) 765-5869
Taxonomy
Speciality
Code
Description
License number
State
261QE0700X
End-Stage Renal Disease (ESRD) Treatment Clinic/Center
Primary
H1905
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139944
BCBS
—
Enumeration date
02/10/2006
Last updated
08/03/2017
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