1821350323 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 1821350323 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 ST. MARY'S HOSPITAL WOUND CARE CENTER AT REYNOLDS CROSSING
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:
1821350323
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6900 FOREST AVE
Provider Second Line Business Mailing Address:
SUITE 115
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23230-1701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-893-8710
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 FOREST AVE
Provider Second Line Business Practice Location Address:
SUITE 115
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23230-1701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-893-8710
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2012

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  H1833 , 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: 1962464016 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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