Bon Secours-Virginia Healthsource

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

BON SECOURS-VIRGINIA HEALTHSOURCE

Doing business as

Glen Allen Internal Medicine

Practice address

5207 Hickory Park Dr
Suite a
Glen Allen, VA 23059

Phone

(804) 621-2980

Fax

(804) 762-7102

NPI assigned

Nov 7, 2007

Last updated

Jul 27, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

BON SECOURS-VIRGINIA HEALTHSOURCEAs reported in NPPES

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

Authorized official

Name

George O. Butler, MBA

Title

Director, Corporate Responsibility

Phone

(804) 281-0271

Specialties & licenses 1

Addresses

Other names 1

• Glen Allen Internal Medicine Doing business as

Part of

Bon Secours-Virginia Health

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

{
    "created_epoch": "1194393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1532649600000",
    "number": "1972783918",
    "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": "804-621-2980",
            "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": "23059",
            "telephone_number": "804-621-2980",
            "fax_number": "804-762-7102"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BON SECOURS-VIRGINIA HEALTHSOURCE",
        "enumeration_date": "2007-11-07",
        "last_updated": "2018-07-27",
        "status": "A",
        "authorized_official_last_name": "BUTLER",
        "authorized_official_first_name": "GEORGE",
        "authorized_official_middle_name": "O.",
        "authorized_official_title_or_position": "DIRECTOR, CORPORATE RESPONSIBILITY",
        "authorized_official_telephone_number": "804-281-0271",
        "authorized_official_credential": "MBA"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Allen Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Glen Allen Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bon Secours Memorial Regional Medical Center LLC (CrossRidge Pediatrics & Internal Medicine)
• Bon Secours Urgent Care LLC
• Bon Secours Virginia Medical Group I, LLC (Bon Secours Surgical Dermatology Center)
• Bon Secours-St. Mary's Hospital of Richmond, Inc. (Glen Allen Internal Medicine)
• Bon Secours-St. Mary's Hospital of Richmond, Inc. (Bon Secours Surgical Dermatology Center)
• Bon Secours-Virginia Healthsource, Inc. (Brook Run Family Physicians)
• Hollis Clay Bondurant, R.PH.
• Bonjour Medical LLC.
• Ryan Bonner
• Ashley Borunda, D.C.

• Internal Medicine Physician in Glen Allen, VA
• Providers in Glen Allen, VA by specialty
• Internal Medicine Physician in Virginia

• 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.