Provider Demographics
NPI:1083676068
Name:BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.
Other - Org Name:BON SECOURS HOME CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:F
Authorized Official - Last Name:GALLAGHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-8413
Mailing Address - Street 1:8580 MAGELLAN PKWY BLDG IV
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-627-5200
Mailing Address - Fax:804-627-5196
Practice Address - Street 1:8580 MAGELLAN PKWY BLDG IV
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-1149
Practice Address - Country:US
Practice Address - Phone:804-627-5200
Practice Address - Fax:804-627-5196
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-05
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004970268Medicaid
112070OtherGENTIVA
31931OtherCARENET
2061877OtherAETNA
44160MPOtherOPTIMA SENTARA
VA114614OtherANTHEM
439597OtherMAMSI
189287OtherSOUTHERN HEALTH
VA497026CMedicare Oscar/Certification