Healthcare Provider Details

I. General information

NPI: 1407218399
Provider Name (Legal Business Name): BON SECOURS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14051 ST FRANCIS BLVD SUITE 2210
MIDLOTHIAN VA
23114-3201
US

IV. Provider business mailing address

14051 ST FRANCIS BLVD SUITE 2210
MIDLOTHIAN VA
23114-3201
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number0024173408
License Number StateVA

VIII. Authorized Official

Name: GEORGE BUTLER
Title or Position: DIRECTOR
Credential:
Phone: 804-281-0271