Provider Demographics
NPI:1255586277
Name:BON SECOURS - RICHMOND COMMUNITY HOSPITAL, INCORPORATED
Entity type:Organization
Organization Name:BON SECOURS - RICHMOND COMMUNITY HOSPITAL, INCORPORATED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF CORP RESPONSIBILITY
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ODELL
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-281-0271
Mailing Address - Street 1:4630 S LABURNUM AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23231-2424
Mailing Address - Country:US
Mailing Address - Phone:804-226-4637
Mailing Address - Fax:804-222-7551
Practice Address - Street 1:4630 S. LABURNUM AVE.
Practice Address - Street 2:SUITE C
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23231
Practice Address - Country:US
Practice Address - Phone:804-226-4637
Practice Address - Fax:804-222-7551
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS - RICHMOND COMMUNITY HOSPITAL, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-18
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1832261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490094Medicare Oscar/Certification