Healthcare Provider Details

I. General information

NPI: 1730516634
Provider Name (Legal Business Name): BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2013
Last Update Date: 10/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 N 28TH ST SUITE 305
RICHMOND VA
23223-5311
US

IV. Provider business mailing address

1510 N 28TH ST SUITE 305
RICHMOND VA
23223-5311
US

V. Phone/Fax

Practice location:
  • Phone: 804-371-1689
  • Fax: 804-371-1678
Mailing address:
  • Phone: 804-371-1689
  • Fax: 804-371-1678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

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