Bon Secours Medical Group Hampton Roads Specialty Care LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC

Doing business as

Southampton Orthopaedic and Sports Medicine Center

Practice address

3920 Bridge Rd Ste 305
Suffolk, VA 23435-1107

Phone

(757) 562-7301

Fax

(757) 562-7305

NPI assigned

Jun 12, 2020

Last updated

May 28, 2024By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Wilbur Gay

Title

Cfo

Phone

(864) 255-1904

Specialties & licenses 2

Addresses

Other names 1

• SOUTHAMPTON ORTHOPAEDIC AND SPORTS MEDICINE CENTER Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1591920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716854400000",
    "number": "1023633369",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "telephone_number": "866-496-9229",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3920 BRIDGE RD STE 305",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234351107",
            "telephone_number": "757-562-7301",
            "fax_number": "757-562-7305"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-12",
        "last_updated": "2024-05-28",
        "certification_date": "2024-05-28",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "WILBUR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-255-1904"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHAMPTON ORTHOPAEDIC AND SPORTS MEDICINE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "SOUTHAMPTON ORTHOPAEDIC AND SPORTS MEDICINE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Brenda Bollenberg
• Chase Bollig, D.C.
• Taylor Anne Bollig, D.C.
• Bon Secours Maryview Nursing Care Center
• Bon Secours Maryview Nursing Care Center LLC
• Bon Secours Medical Group Hampton Roads Specialty Care LLC (Southampton Orthopaedic and Sports Medicine Center)
• Bon Secours Surgery Center at Harbour View, LLC
• Brittani D Bonner, PA-C
• Towana Renee Boone, MBA-MA
• Bound 2 Connect Ministries, Inc.

• Durable Medical Equipment & Medical Supplies in Suffolk, VA
• Providers in Suffolk, VA by specialty
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.