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General NPI Number Information
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NPI Number | 1407218399
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Entity Type | Organization
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Legal Business Name | BON SECOURS
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Dates
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Enumeration Date | 03/22/2016
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Last Update Date | 03/22/2016
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Provider Practice Location Address
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Address Line | 14051 ST FRANCIS BLVD SUITE 2210
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3201
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Country | US
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Telephone | 804-893-8717
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Fax |
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Provider Business Mailing Address
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Address Line | 14051 ST FRANCIS BLVD SUITE 2210
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City | MIDLOTHIAN
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State | VA
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Zip | 23114-3201
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | GEORGE 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 | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 0024173408
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License Number State | VA
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