Healthcare Provider Details

I. General information

NPI: 1487991618
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: 01/08/2013
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD SUITE 104
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

5875 BREMO RD SUITE 104
RICHMOND VA
23226-1934
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-0275
  • Fax: 804-521-9344
Mailing address:
  • Phone: 804-281-0275
  • Fax: 804-521-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

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