Healthcare Provider Details

I. General information

NPI: 1588129480
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: 02/05/2019
Last Update Date: 12/07/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5801 BREMO RD
RICHMOND VA
23226-1907
US

IV. Provider business mailing address

PO BOX 631137
CINCINNATI OH
45263-1137
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2011
  • Fax: 804-287-7906
Mailing address:
  • Phone: 804-627-5462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY RALSTON
Title or Position: SYSTEM DIRECTOR
Credential:
Phone: 419-996-5119