Healthcare Provider Details

I. General information

NPI: 1609950310
Provider Name (Legal Business Name): VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MARSHALL ST
RICHMOND VA
23298-5049
US

IV. Provider business mailing address

PO BOX 758997
BALTIMORE MD
21275-0001
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-6315
  • Fax: 804-828-6872
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH1875
License Number StateVA

VIII. Authorized Official

Name: MR. DOMINIC J. PULEO
Title or Position: CFO
Credential:
Phone: 804-828-1295