Provider Demographics
NPI:1376945626
Name:BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.
Other - Org Name:BON SECOURS BERMUDA CROSSROADS PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CORPORATE RESPONSIBILTY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-0271
Mailing Address - Street 1:12340 BERMUDA CROSSROAD LN
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-2352
Mailing Address - Country:US
Mailing Address - Phone:804-281-0275
Mailing Address - Fax:804-521-9344
Practice Address - Street 1:12340 BERMUDA CROSSROAD LN
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-2352
Practice Address - Country:US
Practice Address - Phone:804-281-0275
Practice Address - Fax:804-521-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-18
Last Update Date:2014-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN