Organization
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER LLC
Active
Other names
CrossRidge Pediatrics & Internal Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
WILBUR GAY (CFO)
(864) 561-7672
Entity
Organization
Contact information
Practice address
10150 STAPLES MILL RD STE C, GLEN ALLEN, VA 23060-3452
(804) 755-7581
(804) 755-7586
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101054649
VA
207RA0000X
Adolescent Medicine (Internal Medicine) Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
09/26/2006
Last updated
09/03/2020
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