Provider Demographics
NPI:1518102235
Name:BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Entity Type:Organization
Organization Name:BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Other - Org Name:CARDIOVASCULAR ASSOCIATES OF VIRGINIA - BON SECOURS MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SYSTEM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:M
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-996-5119
Mailing Address - Street 1:8580 MAGELLAN PKWY
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:
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:7001 FOREST AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-1726
Practice Address - Country:US
Practice Address - Phone:804-288-3123
Practice Address - Fax:804-282-3322
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-09
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09462OtherGROUP PTAN
VAC09462OtherGROUP PTAN