Organization
BON SECOURS-VIRGINIA HEALTHSOURCE
Active
Other names
Bon Secours Home Medical
Organization subpart
No
Provider details
NPI number
Authorized official
GEORGE ODELL BUTLER (DIRECTOR OF CORP RESPONSIBILITY)
(804) 281-0271
Entity
Organization
Contact information
Practice address
8143 STAPLES MILL RD, RICHMOND, VA 23228
(804) 266-2002
(804) 266-1025
Mailing address
7229 FOREST AVE, SUITE 208, RICHMOND, VA 23226-3765
(804) 281-0271
(804) 521-9367
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009135162
—
VA
01
—
070942
ANTHEM BCBS OF VA
VA
01
—
0897250
AETNA
VA
01
—
189262
SOUTHERN HEALTH
VA
01
—
20650
OPTIMA HEALTH
VA
Enumeration date
08/03/2006
Last updated
07/27/2018
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