1730416579 NPI number — BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER

Table of content: (NPI 1730416579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730416579 NPI number — BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
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 BEHAVIORAL HEALTH SERVICES
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:
1730416579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 N 28TH ST
Provider Second Line Business Mailing Address:
3RD FLOOR
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23223-5332
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-371-1675
Provider Business Mailing Address Fax Number:
804-225-1764

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 N 28TH ST
Provider Second Line Business Practice Location Address:
3RD FLOOR
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23223-5332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-371-1675
Provider Business Practice Location Address Fax Number:
804-225-1764
Provider Enumeration Date:
11/16/2009

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C06115 . This is a "GROUP PTAN" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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