1427361922 NPI number — BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427361922 NPI number — BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS-ST. MARY'S HOSPITAL OF RICHMOND, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BON SECOURS PEDIATRIC NEUROLOGY CLINIC
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1427361922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5875 BREMO RD
Provider Second Line Business Practice Location Address:
MOB SOUTH, SUITE 303
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23226-1934
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-287-7080
Provider Business Practice Location Address Fax Number:
804-281-8380
Provider Enumeration Date:
07/26/2010

Additional Information

Authorized Official

Authorized Official Last Name:
QUIRICONI
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
804-281-8301

Provider Taxonomy Codes

  • Taxonomy code: 2080P0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: C06778 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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