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General NPI Number Information
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NPI Number | 1922054287
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Entity Type | Organization
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Legal Business Name | BON SECOURS DEPAUL MEDICAL CENTER IMAGE RECOVERY CENTER
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 150 KINGSLEY LN /SUITE #1 - IMAGE RECOVERY CENTER
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City | NORFOLK
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State | VA
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Zip | 23505-4602
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Country | US
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Telephone | 757-889-5795
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Fax | 757-889-5820
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Provider Business Mailing Address
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Address Line | 150 KINGSLEY LN /SUITE #1 - IMAGE RECOVERY CENTER
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City | NORFOLK
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State | VA
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Zip | 23505-4602
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Country | US
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Telephone | 757-889-5795
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Fax | 757-889-5820
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Authorized Official
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Title or Position | EVP/ADMINISTRATOR
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Name | MR. DANIEL DUGGAN
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Credential |
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Telephone | 757-889-5851
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1202014479
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License Number State | VA
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