Provider Demographics
NPI:1316119332
Name:BON SECOURS DEPAUL MEDICAL CENTER
Entity type:Organization
Organization Name:BON SECOURS DEPAUL MEDICAL CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-673-5928
Mailing Address - Street 1:6161 KEMPSVILLE CIR
Mailing Address - Street 2:SUITE 335
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23502-3932
Mailing Address - Country:US
Mailing Address - Phone:757-466-5027
Mailing Address - Fax:757-466-8110
Practice Address - Street 1:6161 KEMPSVILLE CIR
Practice Address - Street 2:SUITE 335
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23502-3932
Practice Address - Country:US
Practice Address - Phone:757-466-5027
Practice Address - Fax:757-466-8110
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BON SECOURS DEPAUL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-31
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VADD7037Medicare PIN
VAC06209Medicare PIN