Organization
CHESAPEAKE HOSPITAL LLC
Active
Other names
Bon Secours Lively Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M RALSTON (DIRECTOR REIMBURSEMENT)
(419) 996-5119
Entity
Organization
Contact information
Practice address
36 LIVELY OAKS RD, LIVELY, VA 22507
(804) 462-5155
(804) 462-5922
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5573
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
05/14/2018
Last updated
11/20/2020
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