Organization
VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
Active
Other names
VCU Sports Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
DOMINIC J PULEO (CFO)
(804) 828-1295
Entity
Organization
Contact information
Practice address
1300 W BROAD ST, RICHMOND, VA 23284-9089
(804) 828-6315
Mailing address
PO BOX 758997, BALTIMORE, MD 21275-0001
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
H1875
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
180914
ANTHEM-VCU SPORTS MEDICIN
—
Enumeration date
01/04/2007
Last updated
08/22/2020
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up