MEDICARE: BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	112070	OTHER		GENTIVA
3	31931	OTHER		CARENET
4	2061877	OTHER		AETNA
5	44160MP	OTHER		OPTIMA SENTARA
6	114614	OTHER	VA	ANTHEM
7	439597	OTHER		MAMSI
8	189287	OTHER		SOUTHERN HEALTH

General Provider Information

NPI Number	:	1083676068
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	8580 MAGELLAN PKWY BLDG IV
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-627-5200
Fax Number	:	804-627-5196

Provider Business Practice Location Address
First Line	:	8580 MAGELLAN PKWY BLDG IV
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-627-5200
Fax Number	:	804-627-5196

Authorized Official
Title or Position	:	CFO
Name	:	PETER F. GALLAGHER
Credential	:
Telephone Number	:	804-281-8413

Provider Enumeration Date	:	04/05/2006
Last Update Date	:	04/07/2010

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