Organization
BON SECOURS-VIRGINIA HEALTHSOURCE
Active
Parent organization
BON SECOURS-VIRGINIA HEALTHSOURCE
Other names
Dominion Family Physicians
Organization subpart
Yes
Provider details
NPI number
Legal business name
BON SECOURS-VIRGINIA HEALTHSOURCE
Authorized official
GEORGE ODELL BUTLER (DIRECTOR OF CORP RESPONSIBILITY)
(804) 281-0271
Entity
Organization
Contact information
Practice address
4835 S LABURNUM AVE, RICHMOND, VA 23231
(804) 226-4141
(804) 226-4142
Mailing address
4835 S LABURNUM AVE, RICHMOND, VA 23231-2713
(804) 226-4141
(804) 226-4142
Taxonomy
Speciality
Code
Description
License number
State
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
07/27/2018
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