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Organization
BON SECOURS-VIRGINIA HEALTHSOURCE, INC.
Active
Organization
BON SECOURS-VIRGINIA HEALTHSOURCE, INC.
Active
Other names
Brook Run Family Physicians
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN QUIRICONI (CFO)
(804) 281-8301
Entity
Organization
Contact information
Practice address
10571 TELEGRAPH RD, SUITE 130, GLEN ALLEN, VA 23059
(804) 266-7611
(804) 262-9249
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB2823
RAILROAD MEDICARE
VA
Enumeration date
07/08/2006
Last updated
08/30/2019
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