NPIMap

Organization Active NPI

Bon Secours-Virginia Healthsource

  • Family Medicine Physician
  • Richmond, VA
National Provider Identifier
1528091808
Registry record updated Jul 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BON SECOURS-VIRGINIA HEALTHSOURCE
Practice address
3311 Church Rd
Suite 100
Richmond, VA 23233
Phone
(804) 965-9087
Fax
(804) 965-0721
NPI assigned
Jul 9, 2006
Organization subpart
Yes
Parent organization
BON SECOURS-VIRGINIA HEALTHSOURCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 27, 2018

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

Authorized official

Name
George Odell Butler
Title
Director of Corp Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

3311 Church Rd
Suite 100
Richmond, VA 23233

Mailing address

3311 Church Rd
Suite 100
Richmond, VA 23233-1814
Phone (804) 965-9087

Other identifiers 2

IdentifierTypeStateIssuer
CA6615OtherVARAILROAD MEDICARE
CC4370OtherVARAILROAD MEDICARE

Other names 1

  • Tuckahoe Family Medical Center Doing business as

National Provider Directory

National Provider Directory
Part of
Beaverdam Family Phy

Locations

3311 Church Rd
Ste 100
Richmond, VA 23233
Phone (804) 644-1665

3311 Church Rd
Richmond, VA 23233

Practitioners & affiliated clinicians

Practitioners 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1152403200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532649600000",
    "number": "1528091808",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3311 CHURCH RD",
            "address_2": "SUITE 100",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232331814",
            "telephone_number": "804-965-9087",
            "fax_number": "804-965-0721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3311 CHURCH RD",
            "address_2": "SUITE 100",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "23233",
            "telephone_number": "804-965-9087",
            "fax_number": "804-965-0721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
        "enumeration_date": "2006-07-09",
        "last_updated": "2018-07-27",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "ODELL",
        "authorized_official_title_or_position": "DIRECTOR OF CORP RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA6615",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CC4370",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tuckahoe Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tuckahoe Family Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richmond, 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.

Verify at the official NPI Registry.