Organization
EMERGICARE OF SOUTH BOSTON VA INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANTE DE LOS SANTOS BRUNO M.D. (CEO)
(434) 575-7555
Entity
Organization
Contact information
Practice address
1020 BILL TUCK HIGHWAY, SUITE 900, SOUTH BOSTON, VA 24592
(434) 575-7555
(434) 575-5556
Mailing address
1020 BILL TUCK HIGHWAY, SUITE 900, SOUTH BOSTON, VA 24592
(434) 575-7555
(434) 575-5556
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
53781
VA
261QP2300X
Primary Care Clinic/Center
Primary
53781
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
324614
ANTHEM
VA
Enumeration date
10/18/2006
Last updated
01/20/2011
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