Healthcare Provider Details

I. General information

NPI: 1114121050
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: 06/13/2007
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

PO BOX 5508
VIRGINIA BEACH VA
23471
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7644
  • Fax:
Mailing address:
  • Phone: 804-287-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE ODELL BUTLER
Title or Position: DIRECTOR OF CORP RESPONSIBILITY
Credential:
Phone: 804-281-0271