Healthcare Provider Details

I. General information

NPI: 1396083721
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: 01/18/2013
Last Update Date: 10/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5855 BREMO RD SUITE 606
RICHMOND VA
23226-1930
US

IV. Provider business mailing address

5855 BREMO RD SUITE 606
RICHMOND VA
23226-1930
US

V. Phone/Fax

Practice location:
  • Phone: 804-893-8681
  • Fax: 804-287-8525
Mailing address:
  • Phone: 804-893-8681
  • Fax: 804-287-8525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE BUTLER
Title or Position: DIRECTOR CORPORATE RESPONSIBILITY
Credential:
Phone: 804-893-8681