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NPI Code Detail

MEDICARE: BON SECOURS DEPAUL MEDICAL CENTER INC

MEDICARE: BON SECOURS DEPAUL 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1851624688
Entity Type Code : Organization
Provider Name (Legal Business Name) : BON SECOURS DEPAUL MEDICAL CENTER 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 : 1253 NIMMO PKWY STE 110
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23456-7782
Country : US
Telephone Number : 757-425-8590
Fax Number : 757-422-5107
Authorized Official
Title or Position : CFO
Name : STEPHAN QUIRICONI
Credential :
Telephone Number : 804-281-8301
Provider Enumeration Date : 09/11/2009
Last Update Date : 05/16/2019

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Directions to “BON SECOURS DEPAUL MEDICAL CENTER INC ” Practice Location

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