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General NPI Number Information
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NPI Number | 1326379769
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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 | 01/25/2010
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Last Update Date | 10/24/2018
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Provider Practice Location Address
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Address Line | 12720 MCMANUS BLVD SUITE 313
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4414
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Country | US
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Telephone | 757-947-3190
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Fax | 757-947-3195
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Provider Business Mailing Address
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Address Line | 12720 MCMANUS BLVD SUITE 313
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4414
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Country | US
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Telephone | 757-947-3190
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Fax | 757-947-3195
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Authorized Official
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Title or Position | DIRECTOR, CORPORATE RESPONSIBILITY
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Name | GEORGE O. BUTLER
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Credential | MBA
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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 | 207RI0008X
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Taxonomy Name | Hepatology Physician
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License Number | 0101036976
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License Number State | VA
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