SOUTHSIDE KIDNEY SPECIALISTS (NPI# 1508201385) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508201385 |
| Entity Type | Organization |
| Organization Name | SOUTHSIDE KIDNEY SPECIALISTS |
| Practice Address |
3400 S Crater Rd Ste #b Petersburg VA 23805-9252 |
| Mailing Address |
201 E. Ferrell St South Hill VA 23970-2202 |
| Practice Telephone | 8047336960 |
| Practice Fax Number | 8047333880 |
| Mailing Telephone | 4344473455 |
| Mailing Fax Number | 4344473405 |
| Enumeration Date | 2013-05-07 |
| Last Update Date | 2013-05-07 |
| Authorized Official Name | VIJAYA LAKSHMI CHIRUMAMILLA (OWNER) |
| Authorized Official Telephone | 8047336960 |
| Authorized Official Credential | MD |
| Is Organization Subpart | Y |
| Parent Organization Name | SOUTHSIDE KIDNEY SPECIALISTS |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RN0300X |
Internal Medicine Specialization: Nephrology |
Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033130026 | Southside Kidney Specialists | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-07-22 |
| Street Address |
3400 S CRATER RD STE #B |
| City | PETERSBURG |
| State | VA |
| Zip Code | 23805-9252 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710944434 | Sudhakar Chandrakumar Relton | Internal Medicine | 3400 S Crater Rd, Petersburg, VA 23805-9252 | 2006-04-27 |
| 1235376880 | Amar Kumar Damodar | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9252 | 2009-01-18 |
| 1790798379 | Liberty Dialysis - Petersburg LLC | Clinic/Center | 3400 S Crater Rd, Petersburg, VA 23805-9211 | 2006-08-14 |
| 1033130026 | Southside Kidney Specialists | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-07-22 |
| 1669498390 | Tammy Faye Peterson | Dietitian, Registered | 3400 S Crater Rd, Ste.b, Petersburg, VA 23805-9211 | 2006-07-14 |
| 1194773994 | Vijaya Lakshmi Chirumamilla | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134690647 | Miles Viant | Occupational Therapist | 287 E Blvd, Petersburg, VA 23805 | 2018-12-10 |
| 1245756964 | Dexter Shabazz Lett | Registered Nurse | 10543 S. Crater Rd, S. Prince George, VA 23805 | 2017-08-15 |
| 1891145876 | Taylor Enhanced Living | Counselor | 105 Holly Hill Dive, Suite A, Petersburg, VA 23805 | 2016-06-21 |
| 1700255205 | Ina Thompson | Counselor | 272 Medical Park Boulevard, Petersburg, VA 23805 | 2015-09-15 |
| 1932582541 | Valeria Edda Madrid Malo Bohorquez | Internal Medicine | 50 Medical Park Blvd Ste C, Petersburg, VA 23805 | 2015-06-30 |
| 1548642788 | Justin Andrew Phillingane | Podiatrist | 3335 S Crater Rd Ste 500, Petersburg, VA 23805 | 2015-06-24 |
| 1225417082 | Paladin Dermatology LLC | Nurse Practitioner | 44 A& B Medical Park Blvd, Petersburg, VA 23805 | 2015-05-27 |
| 1245652544 | Family Services Inc. | Health Maintenance Organization | 1045 Gustavo Lane, Petersburg, VA 23805 | 2014-01-06 |
| 1619268075 | Charlene Belangia | Massage Therapist | 3323 S. Crater Rd, Suite B, Petersburg, VA 23805 | 2011-04-20 |
| 1760709638 | Caresouth Hha Holdings of Virginia, LLC | Home Health | 34 Medical Park Boulevard, Suite G-h, Petersburg, VA 23805 | 2010-04-30 |
| Find all providers in zip 23805 | ||||
| Taxonomy Code | 207RN0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Nephrology |
| An internist who treats disorders of the kidney, high blood pressure, fluid and mineral balance and dialysis of body wastes when the kidneys do not function. This specialist consults with surgeons about kidney transplantation. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780081059 | Belen Nunez | Internal Medicine | 3400 S Crater Rd Ste B, Petersburg, VA 23805-9252 | 2014-12-02 |
| 1710944434 | Sudhakar Chandrakumar Relton | Internal Medicine | 3400 S Crater Rd, Petersburg, VA 23805-9252 | 2006-04-27 |
| 1235376880 | Amar Kumar Damodar | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9252 | 2009-01-18 |
| 1033130026 | Southside Kidney Specialists | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-07-22 |
| 1194773994 | Vijaya Lakshmi Chirumamilla | Internal Medicine | 3400 S Crater Rd, Suite B, Petersburg, VA 23805-9211 | 2006-05-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316416522 | Southwest Virginia Nephrology LLC | Internal Medicine | 4806 Pleasant Hill Dr Ste 102, Roanoke, VA 24018-3440 | 2018-11-16 |
| 1770903585 | Salah-ud-din Amjad | Internal Medicine | 480 W Jubal Early Dr Ste 200, Winchester, VA 22601 | 2014-04-19 |
| 1699012005 | Barry S. Strauch | Internal Medicine | 1468 Evans Farm Dr, Mc Lean, VA 22101-5652 | 2013-01-07 |
| 1770858847 | Amanda D. Renaghan | Internal Medicine | 199 Spotnap Rd Ste 1, Charlottesville, VA 22911-8827 | 2012-03-21 |
| 1952671067 | Sumeyye Calp Inal | Internal Medicine | 739 Thimble Shoals Blvd Ste 801, Newport News, VA 23606 | 2012-01-05 |
| 1598080186 | Vineet Kumaar Jassal | Internal Medicine | 3930 Walnut St Ste 101, Fairfax, VA 22030-4750 | 2010-04-07 |
| 1538497698 | James Macleod Cox | Internal Medicine | 4222 Coles Point Way, Glen Allen, VA 23060-7242 | 2009-12-01 |
| 1568625408 | Mahesh Krishnan | Internal Medicine | 1371 Lancia Dr, Mc Lean, VA 22102-2230 | 2008-07-09 |
| 1194907527 | Usama Taha Hussein | Internal Medicine | 1800 Camelot Dr Ste 401, Virginia Beach, VA 23454-2440 | 2007-11-27 |
| 1275720559 | Martha Jefferson Medical Group LLC | Internal Medicine | 590 Peter Jefferson Pkwy Ste 300, Charlottesville, VA 22911-4628 | 2007-10-01 |
| Find all providers with the same taxonomy | ||||
| City | PETERSBURG |
| Zip Code | 23805 |
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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.