Healthcare Provider Details

I. General information

NPI: 1265706188
Provider Name (Legal Business Name): BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2012
Last Update Date: 10/05/2021
Certification Date: 10/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 FOREST AVE SUITE 110
RICHMOND VA
23230-1701
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8715
  • Fax: 804-285-1292
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH HARDY
Title or Position: CFO
Credential:
Phone: 937-478-2932