NPIMap

Bon Secours Memorial Regional Medical Center Inc

Organization Active NPI Internal Medicine Physician · Ashland, VA

NPI 1366475642 · NPPES record last updated Jul 11, 2019

Key facts

NPI
1366475642
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC
Practice address
306 Ashcake Rd Ste C
Ashland, VA 23005-2323
Phone
(804) 798-9208
Fax
(804) 798-8108
NPI assigned
Jul 9, 2006
Organization subpart
Yes
Parent organization (as reported)
BON SECOURS MEMORIAL REGIONAL MEDICAL CENTER INC

Authorized official

Name
Stephan Quiriconi
Title
Cfo
Phone
(804) 281-8301

Other NPIs on the same Medicare enrollment 23

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Practitioners 35

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 35

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D1104765Bon Secours Internal Medicine of Ashland
306 Ashcake Road Ste C, Ashland, VA 23005		Certificate of waiverSep 9, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20040726000687 VA Part B Supplier - Clinic/Group Practice 6507775293 Receives reassigned benefits from 75 practitioners
26 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kilmarnock, VA; Glen Allen, VA; Richmond, VA; Mechanicsville, VA; King William, VA

National Provider Directory

Part of
Bon Secours - Memorial Regional Medical Center Inc

Locations

306 Ashcake Rd
Ste C
Ashland, VA 23005
Phone (804) 798-2908

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X Yes

Addresses

Primary practice location

306 Ashcake Rd Ste C
Ashland, VA 23005-2323

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other identifiers

IdentifierTypeStateIssuer
CN8143OtherVARAILROAD MEDICARE

Other names

  • Bon Secours Internal Medicine of Ashland Doing business as

Other providers in Ashland, VA

All providers in Ashland, VA · Internal Medicine Physician in Virginia

Sources for this page

Verify at the official NPI Registry.