Southern Dominion Health System, Inc. in Amelia Court House - Federally Qualified Health Center (fqhc)
Southern Dominion Health System, Inc. - NPI 1700099512
Southern Dominion Health System, Inc. is a Federally Qualified Health Center (fqhc) in Amelia Court House, Virginia. Southern Dominion Health System, Inc. practices all healthcare services and medical treatments related to Federally Qualified Health Center (fqhc). The NPI Number for Southern Dominion Health System, Inc. is 1700099512. The last update date is 2015-11-25.
Southern Dominion Health System, Inc.'s current location address is 8920 Otterburn Rd, Amelia Court House, Virginia. You can contact this provider via phone number 8045615150 and fax number 8045616643. The mailing address for Southern Dominion Health System, Inc. is 8920 Otterburn Rd, Amelia Court House, Virginia. To know further, please read the information below!
Provider Profile Detail
| Provider Organization | Southern Dominion Health System, Inc. |
|---|---|
| Address | 8920 Otterburn Rd, Amelia Court House, Virginia |
| Phone Number | 8045615150 |
| Fax Number | 8045616643 |
| Sole Proprietor | -- |
| Credentials | -- |
Authorized Official
| Title or Position | CFO |
|---|---|
| Authorized Official Name | Seamans W. Jill |
| Telephone Number | 4346962165 |
NPI Number Detail
| NPI Number | 1700099512 |
|---|---|
| Provider Enumeration Date | 2007-05-08 |
| Last Updated Date | 2015-11-25 |
Provider Mailing Address Detail
| Address | 8920 Otterburn Rd |
|---|---|
| City | Amelia Court House |
| State | Virginia (VA) |
| Post Code | 230024854 |
| Phone Number | 8045615150 |
| Fax Number | 8045616643 |
Provider's Primary Taxonomy Detail
| Speciality | Federally Qualified Health Center (fqhc) |
|---|---|
| Taxonomy | 261Qf0400X |
|
Definition: Provides primary and preventive care services in underserved areas, receiving certain federal funding grants. |
|
Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 10192862 | VA | -- |
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What is the Southern Dominion Health System, Inc.'s 1700099512?
The Southern Dominion Health System, Inc.'s NPI (National Provider Identifier) Number is 1700099512. This unique 10-digit identification number is assigned to health care providers by the Centers for Medicare & Medicaid Services (CMS).
Where is the Southern Dominion Health System, Inc. located?
The Southern Dominion Health System, Inc. is located at 8920 Otterburn Rd, Amelia Court House, VA 230024854.
What is Southern Dominion Health System, Inc.'s primary field of medical specialization, and what is the corresponding taxonomy classification code for this area of expertise?
The primary field of medical specialization for Southern Dominion Health System, Inc. is Federally Qualified Health Center (fqhc), and the taxonomy classification code that categorizes this area of expertise is 261Qf0400X.
On what date did the Centers for Medicare & Medicaid Services originally issue the 1700099512 to Southern Dominion Health System, Inc.?
The Centers for Medicare & Medicaid Services originally issued the 1700099512 to Southern Dominion Health System, Inc. on 2007-05-08.
When was the information related to Southern Dominion Health System, Inc. most recently updated or refreshed?
The details pertaining to the Southern Dominion Health System, Inc., including its address, specialty, and other relevant information, were last updated or refreshed on 2015-11-25.
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