Healthcare Provider Details

I. General information

NPI: 1235500281
Provider Name (Legal Business Name): BON SECOURS-VIRGINIA HEALTHSOURCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2015
Last Update Date: 03/02/2021
Certification Date: 03/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7229 FOREST AVE SUITE 112
RICHMOND VA
23226
US

IV. Provider business mailing address

7229 FOREST AVE SUITE 112
RICHMOND VA
23226-3765
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-0275
  • Fax: 804-521-9344
Mailing address:
  • Phone: 804-281-0275
  • Fax: 804-521-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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