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General NPI Number Information
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NPI Number | 1215216387
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Entity Type | Organization
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Legal Business Name | BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
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Dates
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Enumeration Date | 08/08/2011
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 5875 BREMO RD STE 303 MOB SOUTH
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City | RICHMOND
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State | VA
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Zip | 23226-1934
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Country | US
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Telephone | 804-977-8914
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Fax | 804-281-0950
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Provider Business Mailing Address
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Address Line | 5875 BREMO RD STE 303 MOB SOUTH
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City | RICHMOND
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State | VA
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Zip | 23226-1934
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Country | US
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Telephone | 804-977-8914
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Fax | 804-281-0950
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Authorized Official
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Title or Position | DIR. CORP. RESPONSIBILITY
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Name | GEORGE O BUTLER
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Credential |
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Telephone | 804-281-0271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0208X
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Taxonomy Name | Pediatric Infectious Diseases Physician
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License Number |
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License Number State |
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