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Contact Information

SOUTHERN DOMINION HEALTH SYSTEM, INC.
8920 OTTERBURN RD
AMELIA COURT HOUSE, VA23002-4854
 Phone: 804-561-5150
 Fax: 804-561-6643
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Federally Qualified Health Center (FQHC)

261QF0400X B4[14] Federally Qualified Health Center
Indicates primary specialty

NPI Profile & details for SOUTHERN DOMINION HEALTH SYSTEM, INC.

NPI Number 1700099512
LBN Legal business name SOUTHERN DOMINION HEALTH SYSTEM, INC.
Authorized official APRIL KING - (CEO)
Entity Organization
Organization subpart 1 Yes
Enumeration date 05/08/2007
Last updated 02/07/2024 - About 2 years ago
Identifiers
VA Medicaid 010192862
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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