Healthcare Provider Details

I. General information

NPI: 1881795557
Provider Name (Legal Business Name): BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10150 STAPLES MILL RD STE C
GLEN ALLEN VA
23060-3452
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-755-7581
  • Fax: 804-755-7586
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0000X
TaxonomyAdolescent Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101054649
License Number StateVA

VIII. Authorized Official

Name: WILBUR GAY
Title or Position: CFO
Credential:
Phone: 864-561-7672