Healthcare Provider Details

I. General information

NPI: 1316543937
Provider Name (Legal Business Name): BON SECOURS MERCY HEALTH FRANKLIN LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2020
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FAIRVIEW DR
FRANKLIN VA
23851-1238
US

IV. Provider business mailing address

PO BOX 639857
CINCINNATI OH
45263-9857
US

V. Phone/Fax

Practice location:
  • Phone: 757-569-6339
  • Fax:
Mailing address:
  • Phone: 757-569-6339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

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