Healthcare Provider Details

I. General information

NPI: 1013143635
Provider Name (Legal Business Name): BON SECOURS ST FRANCIS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11601 IRON BRIDGE RD SUITE 207
CHESTER VA
23831-1466
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-6880
  • Fax: 804-706-1585
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number0101235914
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number0101235914
License Number StateVA

VIII. Authorized Official

Name: KIMBERLY M RALSTON
Title or Position: SYSTEM DIRECTOR
Credential:
Phone: 419-996-5119