MEDICARE: BON SECOURS VIRGINIA MEDICAL GROUP I, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1982031829
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS VIRGINIA MEDICAL GROUP I, LLC

Provider Business Mailing Address
First Line	:	8239 MEADOWBRIDGE RD
Second Line	:	SUITE A
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2318
Country	:	US
Telephone Number	:	804-730-0800
Fax Number	:	804-730-0839

Provider Business Practice Location Address
First Line	:	8239 MEADOWBRIDGE RD
Second Line	:	SUITE A
City	:	MECHANICSVILLE
State	:	VA
Zip	:	23116-2318
Country	:	US
Telephone Number	:	804-730-0800
Fax Number	:	804-730-0839

Authorized Official
Title or Position	:	DIRECTOR CORPORATE RESPONSIBILITY
Name	:	GEORGE BUTLER
Credential	:
Telephone Number	:	804-281-0271

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	10/10/2013

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