Healthcare Provider Details

I. General information

NPI: 1740798685
Provider Name (Legal Business Name): BON SECOURS AMBULATORY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE STE 200
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

7229 FOREST AVE STE 112
RICHMOND VA
23226-3765
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2300
  • Fax: 804-527-0250
Mailing address:
  • Phone: 804-281-0275
  • Fax: 804-521-9344

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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