Provider Demographics
NPI:1588066567
Name:DOMINION HEART & VASCULAR CLINIC
Entity type:Organization
Organization Name:DOMINION HEART & VASCULAR CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SAQUIB
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:804-571-5000
Mailing Address - Street 1:13000 RIVERS BEND BLVD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8632
Mailing Address - Country:US
Mailing Address - Phone:804-571-5000
Mailing Address - Fax:804-518-1314
Practice Address - Street 1:6 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-1240
Practice Address - Country:US
Practice Address - Phone:434-336-1900
Practice Address - Fax:877-840-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235808207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356789010Medicaid
VAC561Medicare PIN