# BON SECOURS-VIRGINIA HEALTHSOURCE

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BON SECOURS-VIRGINIA HEALTHSOURCE
- **Other names:** Dominion Family Physicians
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043243546
- **Legal business name:** BON SECOURS-VIRGINIA HEALTHSOURCE
- **Authorized official:** GEORGE ODELL BUTLER (DIRECTOR OF CORP RESPONSIBILITY)
- **Authorized official phone:** (804) 281-0271

## Contact information

- **Practice address:** 4835 S LABURNUM AVE, RICHMOND, VA 23231
- **Practice address phone:** (804) 226-4141
- **Practice address fax:** (804) 226-4142
- **Mailing address:** 4835 S LABURNUM AVE, RICHMOND, VA 23231-2713
- **Mailing address phone:** (804) 226-4141
- **Mailing address fax:** (804) 226-4142

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/08/2006
- **Last updated:** 07/27/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | CB2823 | RAILROAD MEDICARE | VA |