1023633369 NPI number — BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC

Table of content: MR. STEPHEN WILLIAM COLEMAN DPT (NPI 1184054868)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023633369 NPI number — BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE 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:
Provider Other Organization Name Type Code:
6
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:
1023633369
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2024
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:
866-496-9229
Provider Business Mailing Address Fax Number:
866-449-0896

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3920 BRIDGE RD STE 305
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-562-7301
Provider Business Practice Location Address Fax Number:
757-562-7305
Provider Enumeration Date:
06/12/2020

Additional Information

Authorized Official

Authorized Official Last Name:
GAY
Authorized Official First Name:
WILBUR
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
864-255-1904

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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