1013143635 NPI number — BON SECOURS ST FRANCIS MEDICAL CENTER LLC

Table of content: (NPI 1013143635)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013143635 NPI number — BON SECOURS ST FRANCIS MEDICAL CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS ST FRANCIS MEDICAL CENTER LLC
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:
NERUOLOGY CLINIC - BON SECOURS MEDICAL GROUP
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:
1013143635
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2022
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:
Provider Business Mailing Address Fax Number:
866-449-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11601 IRON BRIDGE RD
Provider Second Line Business Practice Location Address:
SUITE 207
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23831-1466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-285-6880
Provider Business Practice Location Address Fax Number:
804-706-1585
Provider Enumeration Date:
06/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RALSTON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
M
Authorized Official Title or Position:
SYSTEM DIRECTOR
Authorized Official Telephone Number:
419-996-5119

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  0101235914 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 305R00000X , with the licence number: 0101235914 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: C09633 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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