Healthcare Provider Details

I. General information

NPI: 1841351418
Provider Name (Legal Business Name): VIRGINIA COMMONWEALTH UNIVERSITY HEALTH SYSTEM AUTHORITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 N SOUTHSIDE PLAZA ST
RICHMOND VA
23224-1742
US

IV. Provider business mailing address

PO BOX 758997
BALTIMORE MD
21275-0001
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH ALLEN
Title or Position: VP FINANCE AND ACCOUNTING
Credential:
Phone: 804-628-1338