Healthcare Provider Details

I. General information

NPI: 1295835601
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: 09/25/2006
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 306
RICHMOND VA
23226-1926
US

IV. Provider business mailing address

5855 BREMO RD SUITE 306
RICHMOND VA
23226-1926
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7650
  • Fax: 804-287-7642
Mailing address:
  • Phone: 804-287-7650
  • Fax: 804-287-7642

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