NPIMap

Organization Active NPI

Bon Secours Depaul Medical Center Image Recovery Center

  • Durable Medical Equipment & Medical Supplies
  • Norfolk, VA
National Provider Identifier
1922054287
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
1202014479 Issued in VA
Legal business name
BON SECOURS DEPAUL MEDICAL CENTER IMAGE RECOVERY CENTER
Practice address
150 Kingsley LN
/Suite #1 - Image Recovery Center
Norfolk, VA 23505-4602
Phone
(757) 889-5795
Fax
(757) 889-5820
NPI assigned
May 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Daniel Duggan
Title
Evp/Administrator
Phone
(757) 889-5851

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 1202014479 VA Primary

Addresses

Primary practice location

150 Kingsley LN
/Suite #1 - Image Recovery Center
Norfolk, VA 23505-4602

Mailing address

150 Kingsley LN
/Suite #1 - Image Recovery Center
Norfolk, VA 23505-4602
Phone (757) 889-5795

Other identifiers 1

IdentifierTypeStateIssuer
9109404MedicaidVA

National Provider Directory

National Provider Directory
Tax ID family
Bon Secours Depaul Med Ctr2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

NPI Registry JSON

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

{
    "created_epoch": "1148601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922054287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 KINGSLEY LN",
            "address_2": "/SUITE #1 - IMAGE RECOVERY CENTER",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054602",
            "telephone_number": "757-889-5795",
            "fax_number": "757-889-5820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 KINGSLEY LN",
            "address_2": "/SUITE #1 - IMAGE RECOVERY CENTER",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235054602",
            "telephone_number": "757-889-5795",
            "fax_number": "757-889-5820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS DEPAUL MEDICAL CENTER IMAGE RECOVERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DUGGAN",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_title_or_position": "EVP/ADMINISTRATOR",
        "authorized_official_telephone_number": "757-889-5851",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "1202014479",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9109404",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.