Healthcare Provider Details

I. General information

NPI: 1699906875
Provider Name (Legal Business Name): BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2009
Last Update Date: 09/03/2020
Certification Date: 09/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5875 BREMO RD STE 104 MOB SOUTH
RICHMOND VA
23226-1934
US

IV. Provider business mailing address

8580 MAGELLAN PKWY
RICHMOND VA
23227-1149
US

V. Phone/Fax

Practice location:
  • Phone: 804-287-7770
  • Fax: 804-287-7801
Mailing address:
  • Phone:
  • Fax: 866-449-0896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License Number
License Number State

VIII. Authorized Official

Name: WILBUR GAY
Title or Position: CFO
Credential:
Phone: 864-561-7672