Provider Demographics
NPI:1598336554
Name:BON SECOURS MEDICAL GROUP RICHMOND SPECIALTY CARE LLC
Entity Type:Organization
Organization Name:BON SECOURS MEDICAL GROUP RICHMOND SPECIALTY CARE LLC
Other - Org Name:BON SECOURS - TUCKAHOE ORTHOPEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:WILBUR
Authorized Official - Middle Name:
Authorized Official - Last Name:GAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-605-3762
Mailing Address - Street 1:PO BOX 639969
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-9969
Mailing Address - Country:US
Mailing Address - Phone:804-627-5000
Mailing Address - Fax:866-449-0896
Practice Address - Street 1:8220 MEADOWBRIDGE RD STE 202
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2340
Practice Address - Country:US
Practice Address - Phone:804-285-2300
Practice Address - Fax:804-417-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-09
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty