Healthcare Provider Details

I. General information

NPI: 1912209149
Provider Name (Legal Business Name): BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 07/10/2019
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

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-371-1689
  • Fax: 804-371-1678
Mailing address:
  • Phone: 804-627-5462
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHAN QUIRICONI
Title or Position: CFO
Credential:
Phone: 804-281-8301