Provider Demographics
NPI:1497788798
Name:BON SECOURS-VIRGINIA HEALTHSOURCE
Entity Type:Organization
Organization Name:BON SECOURS-VIRGINIA HEALTHSOURCE
Other - Org Name:WEST END INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR, CORPORATE RESPONSIBILITY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:O
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:804-281-0271
Mailing Address - Street 1:7001 FOREST AVE
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-1724
Mailing Address - Country:US
Mailing Address - Phone:804-282-7857
Mailing Address - Fax:804-282-7899
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 2500
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230
Practice Address - Country:US
Practice Address - Phone:804-282-7857
Practice Address - Fax:804-282-7899
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS-VIRGINIA HEALTHSOURCE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-09
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACG5286OtherRAILROAD MEDICARE
VACG5286OtherRAILROAD MEDICARE
VAC06689Medicare PIN