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Provider Detail for 1629637475
BON SECOURS MEDICAL GROUP HAMPTON ROADS SPECIALTY CARE LLC
Mailing Address:
1701 MERCY HEALTH PL
CINCINNATI, OH 45237-6147
Physical Address:
8580 MAGELLAN PKWY
RICHMOND, VA 23227-1149
Phone: 804-627-5573
Fax: 866-449-0896
Authorized Official:
SHANE HARDY
CFO
937-478-2932
Taxonomy
Allopathic & Osteopathic Physicians/Radiology, Radiation Oncology
Allopathic & Osteopathic Physicians/Surgery
Allopathic & Osteopathic Physicians/Thoracic Surgery (Cardiothoracic Vascular Surgery)
Allopathic & Osteopathic Physicians/Pain Medicine, Pain Medicine
Physician Assistants & Advanced Practice Nursing Providers/Nurse Practitioner
Physician Assistants & Advanced Practice Nursing Providers/Nurse Anesthetist, Certified Registered
Allopathic & Osteopathic Physicians/Internal Medicine, Gastroenterology
License: 207RG0100X
Allopathic & Osteopathic Physicians/Internal Medicine, Pulmonary Disease
Allopathic & Osteopathic Physicians/Internal Medicine, Medical Oncology
Allopathic & Osteopathic Physicians/Obstetrics & Gynecology
Allopathic & Osteopathic Physicians/Obstetrics & Gynecology, Gynecologic Oncology
Allopathic & Osteopathic Physicians/Orthopedic Surgery
Allopathic & Osteopathic Physicians/Psychiatry and Neurology, Neurology
Allopathic & Osteopathic Physicians/Psychiatry
Allopathic & Osteopathic Physicians/Internal Medicine, Cardiovascular Disease
(Primary Specialty)
Last Update: 07/29/2021
Provider Enrollment, Chain and Ownership System (PECOS)
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