SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES – NPI #1174596084
Clinic/Center

SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES is an AHC clinic located in PETERSBURG, VA. NPPES has assigned the NPI number 1174596084 to SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES on February 10, 2006. It is a Type-2 NPI, indicating this NPI number is associated with an organization. Since the name “SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES” is a dba name, the actual legal business name for this organization is PETERSBURG HOSPITAL COMPANY LLC. The primary taxonomy selected by this provider is 261QE0700X from the Health Care Provider Taxonomy code set, which is classified as Clinic/Center, specializing in End-Stage Renal Disease (ESRD) Treatment

The NPI profile was previously updated about 9 years ago on Aug 03, 2017. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES below.

NPI Profile for
PETERSBURG HOSPITAL COMPANY LLC

NPI Number
1174596084
Enumeration Date

(more than 20 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
PETERSBURG HOSPITAL COMPANY LLC
Doing Business As (dba): SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES
Primary location
3335 S CRATER RD
PETERSBURG, VA 23805-9214
Phone: (804) 765-5261 Fax: (804) 765-5869
Mailing address
200 MEDICAL PARK BLVD
PETERSBURG, VA 23805-9274
Phone: (804) 765-5261 Fax: (804) 765-5869
Organization Subpart
No
Authorized Official
PAULA LALOR
DIRECTOR/DELEGATED OFFICIAL
Phone: (615) 925-4565
Updated
Identifiers

Identifiers for SOUTHSIDE REGIONAL MEDICAL CENTER - RENAL SERVICES

Identifiers are used to associate other provider identifiers such as Medicaid or other insurers (ie:, Blue Cross, Blue Shield, Aetna, Kaiser-Permanente, etc.), with their NPI number. These identifiers can be used in matching an NPI number to an insurer's records. However, not all providers have such numbers and not all providers choose to include them in their NPI information.

DescriptionIssuerStateIdentifier
OTHERBCBS139944
Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
261QE0700X
- Clinic/Center / End-Stage Renal Disease (ESRD) Treatment (Primary)
VA H1905

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.