Provider Demographics
NPI:1912334814
Name:BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
Entity type:Organization
Organization Name:BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:8220 MEADOWBRIDGE RD # MOBI
Mailing Address - Street 2:SUITE 308
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23116-2336
Mailing Address - Country:US
Mailing Address - Phone:804-325-8882
Mailing Address - Fax:804-764-3280
Practice Address - Street 1:8220 MEADOWBRIDGE RD # MOBI
Practice Address - Street 2:SUITE 308
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2336
Practice Address - Country:US
Practice Address - Phone:804-325-8882
Practice Address - Fax:804-764-3280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-09
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty