Healthcare Provider Details

I. General information

NPI: 1619304557
Provider Name (Legal Business Name): BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5875 BREMO RD SUITE 303
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

5875 BREMO RD SUITE 303
RICHMOND VA
23226-1934
US

V. Phone/Fax

Practice location:
  • Phone: 804-281-8182
  • Fax: 804-281-8263
Mailing address:
  • Phone: 804-281-8182
  • Fax: 804-281-8263

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