| Dominion Outpatient Services | |
|
1640 E Parham Rd Richmond VA 23228-2368 | |
| (804) 316-6656 | |
| (804) 285-9839 |
| Full Name | Dominion Outpatient Services |
|---|---|
| Speciality | Social Worker |
| Location | 1640 E Parham Rd, Richmond, Virginia |
| Authorized Official Name and Position | Ebony Cowan (BILLING MANAGER) |
| Authorized Official Contact | 8043166656 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Outpatient Services 1640 E Parham Rd Richmond VA 23228-2368 Ph: (804) 316-6656 | Dominion Outpatient Services 1640 E Parham Rd Richmond VA 23228-2368 Ph: (804) 316-6656 |
| NPI Number | 1790932911 |
|---|---|
| Provider Enumeration Date | 08/19/2008 |
| Last Update Date | 12/06/2023 |
| Certification Date | 12/06/2023 |
| 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 | Jessica Blair Knotts |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477118644 PECOS PAC ID: 9335470616 Enrollment ID: I20191017002383 |
| 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 |
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