Provider Demographics
NPI:1750656625
Name:BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:BON SECOURS ST. FRANCIS MEDICAL CENTER, INC.
Other - Org Name:BON SECOURS COMMONWEALTH FERTILITY AND WOMEN'S HEALTH
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:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-0271
Mailing Address - Street 1:13700 ST FRANCIS BLVD STE 502
Mailing Address - Street 2:MOB
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-3223
Mailing Address - Country:US
Mailing Address - Phone:804-594-4700
Mailing Address - Fax:804-594-4701
Practice Address - Street 1:13700 ST FRANCIS BLVD STE 502
Practice Address - Street 2:MOB
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-3223
Practice Address - Country:US
Practice Address - Phone:804-594-4700
Practice Address - Fax:804-594-4701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09633OtherGROUP PTAN