Organization
BON SECOURS ST MARY'S HOSPITAL OF RICHMOND LLC
Active
Other names
Patterson Avenue Family Practice
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M RALSTON (SYSTEM DIRECTOR)
(419) 996-5119
Entity
Organization
Contact information
Practice address
9600 PATTERSON AVE, RICHMOND, VA 23229-6053
(804) 741-6200
(804) 741-6213
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C06778
GROUP PTAN
VA
Enumeration date
11/15/2011
Last updated
10/05/2021
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