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General NPI Number Information
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NPI Number | 1437122645
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Entity Type | Organization
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Legal Business Name | PETERSBURG HOSPITAL COMPANY LLC
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/03/2017
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Provider Practice Location Address
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Address Line | 200 MEDICAL PARK BLVD
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City | PETERSBURG
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State | VA
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Zip | 23805
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Country | US
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Telephone | 804-765-5000
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Fax | 804-765-5962
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Provider Business Mailing Address
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Address Line | PO BOX 501128
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City | SAINT LOUIS
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State | MO
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Zip | 63150-1128
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/DELEGATED OFFICIAL
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Name | PAULA M LALOR
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Credential |
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Telephone | 615-925-4565
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 273R00000X
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Taxonomy Name | Psychiatric Hospital Unit
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License Number | 637-04-001
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License Number State | VA
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