# BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Patterson Avenue Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1780961029
- **Authorized official:** KIMBERLY M RALSTON (SYSTEM DIRECTOR)
- **Authorized official phone:** (419) 996-5119

## Contact information

- **Practice address:** 9600 PATTERSON AVE, RICHMOND, VA 23229-6053
- **Practice address phone:** (804) 741-6200
- **Practice address fax:** (804) 741-6213
- **Mailing address:** 8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
- **Mailing address fax:** (866) 449-0896

## Taxonomy

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

## Other

- **Enumeration date:** 11/15/2011
- **Last updated:** 10/05/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | C06778 | GROUP PTAN | VA |