1457788358 NPI number — BON SECOURS VIRGINIA MEDICAL GROUP I, LLC

Table of content: DR. MICHAEL EDWARD KILLIAN M.D. (NPI 1851342026)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457788358 NPI number — BON SECOURS VIRGINIA MEDICAL GROUP I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS VIRGINIA MEDICAL GROUP I, 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:
1457788358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1510 N 28TH ST
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23223-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-371-1670
Provider Business Mailing Address Fax Number:
804-371-1671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1510 N 28TH ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23223-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-371-1670
Provider Business Practice Location Address Fax Number:
804-371-1671
Provider Enumeration Date:
10/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR CORPORATE RESPONSIBILITY
Authorized Official Telephone Number:
804-281-0271

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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