| Dominion Outpatient Services, Llc | |
|
8100 Three Chopt Rd Rm 101 Richmond VA 23229-4833 | |
| (804) 914-4271 | |
| (804) 285-9839 |
| Full Name | Dominion Outpatient Services, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8100 Three Chopt Rd Rm 101, Richmond, Virginia |
| Authorized Official Name and Position | Ebony Cowan (BILLING MANAGER) |
| Authorized Official Contact | 8049887093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Outpatient Services, Llc 8100 Three Chopt Rd Rm 143 Richmond VA 23229-4833 Ph: (804) 914-4271 | Dominion Outpatient Services, Llc 8100 Three Chopt Rd Rm 101 Richmond VA 23229-4833 Ph: (804) 914-4271 |
| NPI Number | 1790932911 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 07/11/2025 |
| Certification Date | 07/11/2025 |
| Medicare PECOS PAC ID | 5395996920 |
|---|---|
| Medicare Enrollment ID | O20121108000104 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790932911 | NPI | - | NPPES |
| Provider Name | Tracylynn Wickham |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194003459 PECOS PAC ID: 7618140047 Enrollment ID: I20111101000249 |
| Provider Name | Pamela Seward |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1285082255 PECOS PAC ID: 7315203163 Enrollment ID: I20171110000052 |
| Provider Name | Anthony Vincent Santalucia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023596947 PECOS PAC ID: 2668882861 Enrollment ID: I20201029000136 |
| Provider Name | Nympha G Dalgado |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982731154 PECOS PAC ID: 4981076700 Enrollment ID: I20230203002001 |
| Provider Name | Nicholas Santalucia |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255065488 PECOS PAC ID: 5991177644 Enrollment ID: I20230207002089 |
| Provider Name | Osita Mgbendi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639855299 PECOS PAC ID: 3971036195 Enrollment ID: I20241028000264 |
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