Organization
BON SECOURS DEPAUL MEDICAL CENTER IMAGE RECOVERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DANIEL DUGGAN (EVP/ADMINISTRATOR)
(757) 889-5851
Entity
Organization
Contact information
Practice address
150 KINGSLEY LN, /SUITE #1 - IMAGE RECOVERY CENTER, NORFOLK, VA 23505-4602
(757) 889-5795
(757) 889-5820
Mailing address
150 KINGSLEY LN, /SUITE #1 - IMAGE RECOVERY CENTER, NORFOLK, VA 23505-4602
(757) 889-5795
(757) 889-5820
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1202014479
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9109404
—
VA
Enumeration date
05/26/2006
Last updated
08/22/2020
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