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General NPI Number Information
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NPI Number | 1710562723
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Entity Type | Organization
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Legal Business Name | BON SECOURS MERCY HEALTH PETERSBURG LLC
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Dates
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Enumeration Date | 03/11/2021
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Last Update Date | 03/11/2021
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Provider Practice Location Address
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Address Line | 60 E ROSLYN CT
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City | COLONIAL HEIGHTS
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State | VA
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Zip | 23834-2980
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Country | US
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Telephone | 804-765-6700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 639859
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City | CINCINNATI
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State | OH
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Zip | 45263-9859
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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 | SYSTEM DIRECTOR
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Name | KIMBERLY M RALSTON
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Credential |
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Telephone | 419-996-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number |
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License Number State |
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