Basic Information
| Provider Information | |||||||||
| NPI: | 1821335365 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5801 BREMO RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850620 | ||||||||
| FaxNumber: | 8042850726 | ||||||||
| Practice Location | |||||||||
| Address1: | 5801 BREMO RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232261907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042850620 | ||||||||
| FaxNumber: | 8042850726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/03/2013 | ||||||||
| LastUpdateDate: | 10/24/2018 | ||||||||
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| AuthorizedOfficialLastName: | BUTLER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | ODELL | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF CORP RESPONSIBILITY | ||||||||
| AuthorizedOfficialTelephone: | 8042810271 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.