Provider Demographics
NPI:1457505711
Name:BON SECOURS DEPAUL MEDICAL CENTER
Entity Type:Organization
Organization Name:BON SECOURS DEPAUL MEDICAL CENTER
Other - Org Name:BON SECOURS PROVIDENCE MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-673-5928
Mailing Address - Street 1:5301 PROVIDENCE RD
Mailing Address - Street 2:SUITE 90
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4128
Mailing Address - Country:US
Mailing Address - Phone:757-495-6896
Mailing Address - Fax:757-474-2223
Practice Address - Street 1:5301 PROVIDENCE RD
Practice Address - Street 2:SUITE 90
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4128
Practice Address - Country:US
Practice Address - Phone:757-495-6896
Practice Address - Fax:757-474-2223
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS DEPAUL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty