Healthcare Provider Details

I. General information

NPI: 1982857231
Provider Name (Legal Business Name): BON SECOURS-VIRGINIA HEALTHSOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2008
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 IRON BRIDGE RD SUITE 209
CHESTER VA
23831
US

IV. Provider business mailing address

14051 ST FRANCIS BLVD SUITE 2202
MIDLOTHIAN VA
23114-3201
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-6856
  • Fax: 804-706-9515
Mailing address:
  • Phone: 804-594-4790
  • Fax: 804-594-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: GEORGE O BUTLER
Title or Position: DIRECTOR, CORPORATE RESPONSIBILITY
Credential: MBA
Phone: 804-281-0271