NPIMap

Organization Active NPI

Bon Secours Virginia Medical Group I, LLC

Doing business as Bon Secours Surgical Dermatology Center

  • Dermatology Physician
  • Glen Allen, VA
National Provider Identifier
1568899409
Registry record updated Oct 10, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
BON SECOURS VIRGINIA MEDICAL GROUP I, LLC
Doing business as
Bon Secours Surgical Dermatology Center
Practice address
5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059-2624
Phone
(804) 977-8938
Fax
(804) 762-7102
NPI assigned
Oct 10, 2013
Last updated
Oct 10, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2013

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

Authorized official

Name
George Butler
Title
Director Corporate Responsibility
Phone
(804) 281-0271

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059-2624

Mailing address

5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059-2624
Phone (804) 977-8938

Other names 1

  • Bon Secours Surgical Dermatology Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Bon Secours Virginia Medical Group I LLC20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

Organizations that report the same tax identification number in the National Provider Directory.

View all 19

Locations

5207 Hickory Park Dr
Ste A
Glen Allen, VA 23059
Phone (804) 326-4448

NPI Registry JSON

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

{
    "created_epoch": "1381363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381363200000",
    "number": "1568899409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5207 HICKORY PARK DR",
            "address_2": "SUITE A",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230592624",
            "telephone_number": "804-977-8938",
            "fax_number": "804-762-7102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5207 HICKORY PARK DR",
            "address_2": "SUITE A",
            "city": "GLEN ALLEN",
            "state": "VA",
            "postal_code": "230592624",
            "telephone_number": "804-977-8938",
            "fax_number": "804-762-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS VIRGINIA MEDICAL GROUP I, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-10",
        "last_updated": "2013-10-10",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_title_or_position": "DIRECTOR CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Surgical Dermatology Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Allen, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2013; 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.