Provider Demographics
NPI:1568505899
Name:BON SECOURS SURGERY CENTER AT HARBOUR VIEW, LLC
Entity Type:Organization
Organization Name:BON SECOURS SURGERY CENTER AT HARBOUR VIEW, LLC
Other - Org Name:BON SECOURS SURGERY CENTER AT HARBOUR VIEW
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-376-7315
Mailing Address - Street 1:5818 HARBOUR VIEW BLVD
Mailing Address - Street 2:STE 102D
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3315
Mailing Address - Country:US
Mailing Address - Phone:757-673-5832
Mailing Address - Fax:757-673-5880
Practice Address - Street 1:5818 HARBOUR VIEW BLVD
Practice Address - Street 2:STE 102D
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3315
Practice Address - Country:US
Practice Address - Phone:757-673-5832
Practice Address - Fax:757-673-5880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAOH711261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
192949775Medicare PIN
49C0001049Medicare Oscar/Certification