MEDICARE: BON SECOURS-VIRGINIA HEALTHSOURCE 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	208600000X	Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C06695	OTHER	VA	GROUP PTAN

General Provider Information

NPI Number	:	1487922183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BON SECOURS-VIRGINIA HEALTHSOURCE INC

Provider Business Mailing Address
First Line	:	8580 MAGELLAN PKWY
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23227-1149
Country	:	US
Telephone Number	:	804-627-5462
Fax Number	:	866-449-0896

Provider Business Practice Location Address
First Line	:	5855 BREMO RD STE 506
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23226-1925
Country	:	US
Telephone Number	:	804-285-3225
Fax Number	:	804-285-0360

Authorized Official
Title or Position	:	CFO
Name	:	STEPHAN QUIRICONI
Credential	:
Telephone Number	:	804-281-8301

Provider Enumeration Date	:	12/08/2011
Last Update Date	:	06/14/2019

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Directions to “BON SECOURS-VIRGINIA HEALTHSOURCE INC ” Practice Location

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