Medical School Information |
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Medical School Name
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AT STILL UNIVERSITY, ARIZONA SCHOOL OF DENTISTRY & ORAL HLTH
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Individual professional's medical school
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Graduation Year
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2015
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Individual professional's medical school graduation year
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Primary Specialty
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INTERNAL MEDICINE
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Primary medical specialty reported by the individual professional in the selected enrollment
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Secondary Specialty 1
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HOSPITALIST
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First secondary medical specialty reported by the individual professional in the selected enrollment
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All Secondary Specialties
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HOSPITALIST
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All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas
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Practice Information |
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Organization Legal Name
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SOUTHEASTERN INTENSIVIST SERVICES PC
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Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
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Group Practice PAC ID
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9335152107
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Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
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Number of Group Practice members
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135
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Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
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Line 1 Street Address
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411 W RANDOLPH RD
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Group Practice or individual's line 1 address
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City
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HOPEWELL
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Group Practice or individual's city
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State
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VA
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Group Practice or individual's state
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Zip Code
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238602938
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Group Practice or individual's zip code (9 digits when available)
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Phone Number
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8045411600
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Phone number is listed only when there is a single phone number available for the practice location address
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Hospital(s) Affiliation Information |
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Hospital Affiliation CCN 1
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490069
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Medicare CCN of hospital where individual professional provides service 1
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Hospital Affiliation LBN 1
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BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
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Legal business name of hospital where individual professional provides service 1
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Hospital Affiliation CCN 2
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491308
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Medicare CCN of hospital where individual professional provides service 2
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Hospital Affiliation LBN 2
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RAPPAHANNOCK GENERAL HOSPITAL
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Legal business name of hospital where individual professional provides service 2
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Hospital Affiliation CCN 3
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490112
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Medicare CCN of hospital where individual professional provides service 3
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Hospital Affiliation LBN 3
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CJW MEDICAL CENTER
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Legal business name of hospital where individual professional provides service 3
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Hospital Affiliation CCN 4
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210003
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Medicare CCN of hospital where individual professional provides service 4
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Hospital Affiliation LBN 4
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UNIVERSITY OF MD PRINCE GEORGE'S HOSPITAL CTR
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Legal business name of hospital where individual professional provides service 4
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Hospital Affiliation CCN 5
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490084
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Medicare CCN of hospital where individual professional provides service 5
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Hospital Affiliation LBN 5
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RIVERSIDE TAPPAHANNOCK HOSPITAL
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Legal business name of hospital where individual professional provides service 5
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Professional Accepts Medicare Assignment
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Y
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