Active NPI
Bon Secours-Virginia Healthsource
- Endocrinology, Diabetes & Metabolism Physician
- Colonial Heights, VA
National Provider Identifier
1356529341
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endocrinology, Diabetes & Metabolism Physician
- License
- 0101236869
- Legal business name
- BON SECOURS-VIRGINIA HEALTHSOURCE
- Practice address
- 3660 Boulevard
Suite G
Colonial Heights, VA 23834 - Phone
- (804) 526-5566
- Fax
- (804) 526-5568
- NPI assigned
- Feb 1, 2008
- Organization subpart
- Yes
- Parent organization
- BON SECOURS-VIRGINIA HEALTHSOURCE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. George O. Butler, MBA
- Title
- Director, Corporate Responsibility
- Phone
- (804) 281-0271
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endocrinology, Diabetes & Metabolism Physician | 207RE0101X | 0101236869 | VA | Primary |
Addresses
Primary practice location
3660 Boulevard
Suite G
Colonial Heights, VA 23834
Mailing address
3660 Boulevard
Suite G
Colonial Heights, VA 23834-1345
Phone (804) 526-5566
Other names 1
- CARE Diabetes and Endocrinology
National Provider Directory
National Provider Directory- Part of
- Beaverdam Family Phy
Locations
3660 Boulevard
Ste G
Colonial Hgts, VA 23834
Phone (804) 526-5566
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1201824000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1532649600000",
"number": "1356529341",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3660 BOULEVARD",
"address_2": "SUITE G",
"city": "COLONIAL HEIGHTS",
"state": "VA",
"postal_code": "238341345",
"telephone_number": "804-526-5566",
"fax_number": "804-526-5568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3660 BOULEVARD",
"address_2": "SUITE G",
"city": "COLONIAL HEIGHTS",
"state": "VA",
"postal_code": "23834",
"telephone_number": "804-526-5566",
"fax_number": "804-526-5568"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
"enumeration_date": "2008-02-01",
"last_updated": "2018-07-27",
"status": "A",
"authorized_official_last_name": "BUTLER",
"authorized_official_first_name": "GEORGE",
"authorized_official_middle_name": "O.",
"authorized_official_title_or_position": "DIRECTOR, CORPORATE RESPONSIBILITY",
"authorized_official_telephone_number": "804-281-0271",
"authorized_official_name_prefix": "Mr.",
"authorized_official_credential": "MBA"
},
"taxonomies": [
{
"code": "207RE0101X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
"state": "VA",
"license": "0101236869",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "CARE Diabetes and Endocrinology",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "CARE Diabetes and Endocrinology",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Colonial Heights, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.