Bon Secours Depaul Medical Center

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

Legal business name

BON SECOURS DEPAUL MEDICAL CENTER

Practice address

4445 Corporation LN
Suite 120
Virginia Beach, VA 23462-3262

Phone

(757) 399-0759

NPI assigned

Feb 17, 2011

Organization subpart

Yes

Parent organization

BON SECOURS DEPAUL MEDICAL CENTERAs reported in NPPES

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

Authorized official

Name

Michael K Kerner

Title

Ceo

Phone

75767359259

Specialties & licenses 1

Addresses

Other names 1

• Bon Secours Neuroscience Center for Pain Management Doing business as

Part of

Bon Secours Depaul Med Ctr

Locations

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1333324800000",
    "number": "1669779252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN",
            "address_2": "SUITE 120",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623262",
            "telephone_number": "757-399-0759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 CORPORATION LN",
            "address_2": "SUITE 120",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234623262",
            "telephone_number": "757-399-0759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS DEPAUL MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS DEPAUL MEDICAL CENTER",
        "enumeration_date": "2011-02-17",
        "last_updated": "2012-04-02",
        "status": "A",
        "authorized_official_last_name": "KERNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "75767359259"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bon Secours Neuroscience Center for Pain Management",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Imani Bolton
• Leslie Roy Bolton, IDC
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc
• Bon Secours Depaul Medical Center Inc
• Olivia Bonanno, CNP

• Pain Medicine Physician in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Pain Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2012; 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.