SOUTHERN DOMINION HEALTH SYSTEM (NPI# 1104067701) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104067701 |
| Entity Type | Organization |
| Organization Name | SOUTHERN DOMINION HEALTH SYSTEM |
| Practice Address |
8631 Namozine Rd Amelia Court House VA 23002-3410 |
| Practice Telephone | 8045616263 |
| Mailing Telephone | 8045616263 |
| Enumeration Date | 2009-03-12 |
| Last Update Date | 2009-03-12 |
| Authorized Official Name | MS. MARY R TURNER (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Telephone | 4346962165 |
| Authorized Official Credential | CEO |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 0========= | VA | Ambulatory Health Care Facilities |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | SOUTHERN DOMINION HEALTH SYSTEMS Inc. | 1508 Kv Road, Po Box 70, Victoria, Virginia 23974 |
| Street Address |
8631 NAMOZINE RD |
| City | AMELIA COURT HOUSE |
| State | VA |
| Zip Code | 23002-3410 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548251622 | Mary F Basco | Internal Medicine | 8631 Namozine Rd, Amelia Court House, VA 23002-3410 | 2005-10-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013451269 | Travis Mueller, Dds | Dentist | 16320 Goodes Bridge Rd, Amelia Court House, VA 23002 | 2016-12-07 |
| 1811256787 | Southern Dominion Health System, Inc. | Clinic/Center | 8830 Virginia Street, Amelia, VA 23002 | 2012-05-11 |
| 1619118403 | Michele Monday Donoghue | Nurse Practitioner | 8631 Namozine Road, Amelia, VA 23002 | 2009-03-09 |
| 1811058449 | Jennifer Reed Mueller | Dentist | 16320 Goodes Bridge Rd., Amelia, VA 23002 | 2006-12-13 |
| 1881615458 | Carmen E Greiner | Counselor | Church Street & Washington Street, Amelia, VA 23002 | 2006-07-21 |
| 1194701177 | Leatha F Boyles | Nurse Practitioner | 8920 Otterbrun Road, Amelia, VA 23002 | 2005-12-21 |
| 1851373559 | Debra Marie Sequeira | Family Medicine | 8920 Otterburn Road, Amelia, VA 23002 | 2005-11-17 |
| 1447540497 | Ryan Keith Ickes | Social Worker | 9101 Washington Street, Amelia, VA 23002 | 2011-04-12 |
| 1497983175 | Rita M Barrett | Nurse Practitioner | 8920 Otterburn Road, Amelia, VA 23002 | 2009-07-01 |
| 1508003484 | Nadeem Ahmed | Psychologist | 9101 Washington Street, Amelia Ch, VA 23002 | 2009-01-14 |
| Find all providers in zip 23002 | ||||
| Taxonomy Code | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
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| 1770122723 | Colonial Beach Health & Wellness Inc | Clinic/Center | 700 Mckinney Blvd Ste 1100, Colonial Beach, VA 22443-1934 | 2019-12-21 |
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| 1720639503 | Javan Wellness Ballston LLC | Clinic/Center | 4000 Wilson Blvd Ste D, Arlington, VA 22203-4401 | 2019-09-24 |
| Find all providers with the same taxonomy | ||||
| City | AMELIA COURT HOUSE |
| Zip Code | 23002 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.