Healthcare Provider Details

I. General information

NPI: 1972785053
Provider Name (Legal Business Name): BON SECOURS-VIRGINIA HEALTHSOURCE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8266 ATLEE RD STE 215
MECHANICSVILLE VA
23116-1805
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-559-6181
  • Fax: 804-559-6185
Mailing address:
  • Phone: 804-627-5462
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: STEPHAN QUIRICONI
Title or Position: CFO
Credential:
Phone: 804-281-8301