Organization
BON SECOURS-VIRGINIA HEALTHSOURCE INC
Active
Other names
Primary Health Care Associates
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHAN QUIRICONI (CFO)
(804) 281-8301
Entity
Organization
Contact information
Practice address
1510 N 28TH ST STE 308, RICHMOND, VA 23223-5311
(804) 644-1665
(804) 644-5285
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5462
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG5286
RAILROAD MEDICARE
VA
Enumeration date
07/09/2006
Last updated
06/11/2019
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