Healthcare Provider Details

I. General information

NPI: 1497788806
Provider Name (Legal Business Name): BON SECOURS ST. FRANCIS MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13540 HULL STREET RD
MIDLOTHIAN VA
23112
US

IV. Provider business mailing address

PO BOX 639993
CINCINNATI OH
45263-9993
US

V. Phone/Fax

Practice location:
  • Phone: 804-739-6142
  • Fax: 804-739-8923
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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