Provider Demographics
NPI:1548613110
Name:SOUTH HILL WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:SOUTH HILL WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:H
Authorized Official - Last Name:HERRSCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-447-8996
Mailing Address - Street 1:107 N BRUNSWICK AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH HILL
Mailing Address - State:VA
Mailing Address - Zip Code:23970-1909
Mailing Address - Country:US
Mailing Address - Phone:434-447-8996
Mailing Address - Fax:
Practice Address - Street 1:107 N BRUNSWICK AVE
Practice Address - Street 2:
Practice Address - City:SOUTH HILL
Practice Address - State:VA
Practice Address - Zip Code:23970-1909
Practice Address - Country:US
Practice Address - Phone:434-447-8996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-19
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104000298111N00000X
261QM1300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1295828002Medicare NSC