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
200 MEDICAL PARK BLVD, PETERSBURG, VA 23805
(804) 765-5000
(804) 765-5962
Mailing address
PO BOX 501128, SAINT LOUIS, MO 63150-1128
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
H1905
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
442492
BCBS
—
05
—
4451697
—
VA
Enumeration date
02/09/2006
Last updated
08/03/2017
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