Healthcare Provider Details

I. General information

NPI: 1306175682
Provider Name (Legal Business Name): BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 GASKINS RD SUITE 110
RICHMOND VA
23233
US

IV. Provider business mailing address

3850 GASKINS RD SUITE 110
RICHMOND VA
23233-1447
US

V. Phone/Fax

Practice location:
  • Phone: 804-217-9601
  • Fax: 804-217-9602
Mailing address:
  • Phone: 804-217-9601
  • Fax: 804-217-9602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: GEORGE O BUTLER
Title or Position: DIRECTOR, CORPORATE RESPONSIBILITY
Credential: MBA
Phone: 804-281-0271