Organization
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Active
Parent organization
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Other names
Pediatric Lung Care - Bon Secours Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Authorized official
WILBUR GAY (CFO)
(864) 561-7672
Entity
Organization
Contact information
Practice address
5875 BREMO RD STE 104, MOB SOUTH, RICHMOND, VA 23226-1934
(804) 287-7770
(804) 287-7801
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
08/05/2009
Last updated
09/03/2020
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