Provider Demographics
NPI:1386086643
Name:BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CORPORATE RESPONSIBILTY
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 1:390 VIRGINIA ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:URBANNA
Mailing Address - State:VA
Mailing Address - Zip Code:23175-9903
Mailing Address - Country:US
Mailing Address - Phone:804-285-6020
Mailing Address - Fax:804-758-2765
Practice Address - Street 1:390 VIRGINIA ST
Practice Address - Street 2:SUITE A
Practice Address - City:URBANNA
Practice Address - State:VA
Practice Address - Zip Code:23175-9903
Practice Address - Country:US
Practice Address - Phone:804-285-6020
Practice Address - Fax:804-758-2765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-26
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC06115OtherGROUP PTAN