| Southern Dominion Health System, Inc. | |
|
1508 K V Rd Victoria VA 23974-2624 | |
| (434) 696-2165 | |
| (434) 696-1378 |
| Full Name | Southern Dominion Health System, Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 1508 K V Rd, Victoria, Virginia |
| Authorized Official Name and Position | April King (CEO) |
| Authorized Official Contact | 4346962165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southern Dominion Health System, Inc. Po Box 70 Victoria VA 23974-0070 Ph: (434) 696-2165 | Southern Dominion Health System, Inc. 1508 K V Rd Victoria VA 23974-2624 Ph: (434) 696-2165 |
| NPI Number | 1295706588 |
|---|---|
| Provider Enumeration Date | 01/27/2006 |
| Last Update Date | 02/07/2024 |
| Medicare PECOS PAC ID | 0648188755 |
|---|---|
| Medicare Enrollment ID | O20040611000631 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295706588 | NPI | - | NPPES |
| Provider Name | Debra M Sequeira |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1851373559 PECOS PAC ID: 1355249392 Enrollment ID: I20051019000412 |
| Provider Name | Fitzgerald Marcelin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285818229 PECOS PAC ID: 0244392660 Enrollment ID: I20081218000757 |
| Provider Name | Rita M Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497983175 PECOS PAC ID: 6800932971 Enrollment ID: I20091002000100 |
| Provider Name | Virginia May Short |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457675720 PECOS PAC ID: 6103957097 Enrollment ID: I20100621000553 |
| Provider Name | Hyo Kwon Park |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1730170770 PECOS PAC ID: 7618981622 Enrollment ID: I20101115000893 |
| Provider Name | Margaret R Campbell |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1245246230 PECOS PAC ID: 0143405381 Enrollment ID: I20110503000348 |
| Provider Name | Shannon L Rakes |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629403209 PECOS PAC ID: 2365765724 Enrollment ID: I20141216002363 |
| Provider Name | Elizabeth M Buchanan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932592987 PECOS PAC ID: 5294055448 Enrollment ID: I20150529000409 |
| Provider Name | Juliette B Staples |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023566908 PECOS PAC ID: 4880975739 Enrollment ID: I20170109000273 |
| Provider Name | Margaret K Inge |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174934954 PECOS PAC ID: 1658591698 Enrollment ID: I20170802003203 |
| Provider Name | Amanda L Russell |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1114312295 PECOS PAC ID: 6709193469 Enrollment ID: I20180919002068 |
| Provider Name | Kasey Rae Gaulden |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639658065 PECOS PAC ID: 4981957602 Enrollment ID: I20181026001518 |
| Provider Name | Anna Turton Hues |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134473150 PECOS PAC ID: 9830420728 Enrollment ID: I20191007003657 |
| Provider Name | Rasha A Kafi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154962231 PECOS PAC ID: 8921428673 Enrollment ID: I20201019000705 |
| Provider Name | Courtney Shane Barrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1376191197 PECOS PAC ID: 0345632840 Enrollment ID: I20220112002922 |
| Provider Name | Heather M Gigon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205140605 PECOS PAC ID: 9739348921 Enrollment ID: I20221119000484 |
| Provider Name | Ashleigh Marie Huff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306553888 PECOS PAC ID: 3375913437 Enrollment ID: I20230105002261 |
| Provider Name | Jerren M Alcalde |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1164919304 PECOS PAC ID: 2769836782 Enrollment ID: I20231016002871 |
Sdhs Counseling & Behavioral Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1508 K V Rd, Victoria, VA 23974 Phone: 434-696-2319 Fax: 434-696-2326 | |
Sdhs Family Dentistry Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1418 6th Street, Victoria, VA 23974 Phone: 434-696-4180 Fax: 434-696-4182 | |
Housecalls For The Homebound Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1508 K V Road, Victoria, VA 23974 Phone: 434-696-2165 Fax: 434-696-1557 | |
Lunenburg Medical Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 1508 K-v Road, Victoria, VA 23974 Phone: 434-696-2165 Fax: 434-696-1378 |