BON SECOURS DEPAUL MEDICAL CENTER LLC (NPI# 1619001906) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619001906 |
| Entity Type | Organization |
| Organization Name | BON SECOURS DEPAUL MEDICAL CENTER LLC |
| Other Organization Name | DEPAUL MEDICAL ASSOCIATES |
| Practice Address |
155 Kingsley Ln Ste 400 Norfolk VA 23505-4629 |
| Mailing Address |
8580 Magellan Pkwy Richmond VA 23227-1149 |
| Practice Telephone | 7572782240 |
| Practice Fax Number | 7574896469 |
| Mailing Fax Number | 8664490896 |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2020-09-22 |
| Authorized Official Name | WILBUR GAY (CFO) |
| Authorized Official Telephone | 8645617672 |
| Is Organization Subpart | Y |
| Parent Organization Name | BON SECOURS DEPAUL MEDICAL CENTER LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | Allopathic & Osteopathic Physicians | ||
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| DePaul Medical Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770643835 | Bon Secours Depaul Medical Center LLC | Nurse Anesthetist, Certified Registered | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2006-12-11 |
| 1134137615 | Bon Secours Depaul Medical Center LLC | General Acute Care Hospital | 150 Kingsley Ln, Norfolk, VA 23505-4602 | 2006-08-03 |
| Street Address |
155 KINGSLEY LN STE 400 |
| City | NORFOLK |
| State | VA |
| Zip Code | 23505-4629 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548894165 | Bethany Lynn Cahill | Nurse Practitioner | 155 Kingsley Ln Ste 400, Norfolk, VA 23505-4629 | 2020-02-24 |
| 1750892741 | Marie Mcdermott Carlson | Nurse Practitioner | 155 Kingsley Ln Ste 400, Norfolk, VA 23505-4629 | 2017-10-17 |
| 1285161828 | Susana Villate Prieto | Family Medicine | 155 Kingsley Ln Ste 400, Norfolk, VA 23505-4629 | 2017-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154844256 | Cassandra Shelton | Specialist/Technologist, Other | 100 Kingsley Lane, Norfolk, VA 23505 | 2017-07-20 |
| 1063942852 | Gabriela Marie Santiago | Specialist/Technologist | 7600 Victory Dr, Apt 3, Norfolk, VA 23505 | 2017-06-14 |
| 1144776725 | Amr Hassan | Pharmacist | 1610 W Little Creek Rd, Apt 204, Norfolk, VA 23505 | 2016-09-01 |
| 1992175095 | Heather Mitchell | Nurse Practitioner | 110 Kingsley Ln Ste 309, Norfolk, VA 23505 | 2015-10-01 |
| 1255710620 | Jessica Ann Kestranek | Dentist | 7400 Granby St Ste D, Norfolk, VA 23505 | 2015-05-19 |
| 1710375274 | Carla Toledo | Nurse Practitioner | 155 Kingsley Lane, Suite 400, Norfolk, VA 23505 | 2015-01-06 |
| 1417359746 | James Austin Valone Jr. | Ophthalmology | 1423 Runymede Rd, Norfolk, VA 23505 | 2014-09-18 |
| 1861813370 | Harris Teeter, LLC | Pharmacy | 7550 Granby Street, Norfolk, VA 23505 | 2013-12-31 |
| 1649549361 | Linda Horsey | Social Worker | 7510 Granby Street, Suite 6, Norfolk, VA 23505 | 2011-12-27 |
| 1679705164 | Carolyn Lee Kee | Nurse's Aide | 7403 Hampton Blvd, Norfolk, VA 23505 | 2009-08-17 |
| Find all providers in zip 23505 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144708371 | Alison Stover | Family Medicine | 110 N 29th St Ste 101, Norfolk, NE 68701-4461 | 2018-07-31 |
| 1689169344 | Faith Regional Physician Services, LLC | Family Medicine | 110 N 29th St Ste 201, Norfolk, NE 68701-4461 | 2018-06-26 |
| 1558879346 | Sentara Medical Group | Family Medicine | 301 Riverview Ave Ste 930, Norfolk, VA 23510-1068 | 2018-01-16 |
| 1194243410 | Nmg LLC | Family Medicine | 301 N 27th St Ste 1, Norfolk, NE 68701-4457 | 2017-09-07 |
| 1356864995 | Nmg LLC | Family Medicine | 301 North 27th Street Suite 1, Norfolk, NE 68701 | 2017-07-25 |
| 1063864981 | Losika Sivaganeshan | Family Medicine | 900 W Norfolk Ave Ste 100, Norfolk, NE 68701-5006 | 2016-07-02 |
| 1235506387 | Jason Charles Evers | Family Medicine | 999 Waterside Dr Ste 2525, Norfolk, VA 23510-3316 | 2015-08-25 |
| 1992185011 | Marcia Nicole Newby-goodman | Family Medicine | 930 Majestic Ave Ste 220, Norfolk, VA 23504-4055 | 2015-06-03 |
| 1124438437 | Bon Secours Depaul Medical Center Inc | Family Medicine | 4211 Monarch Way, Norfolk, VA 23508-2540 | 2014-05-08 |
| 1629489935 | Joshua Robert Beer | Family Medicine | 1363 Magnolia Ave, Norfolk, VA 23508-1121 | 2014-05-08 |
| Find all providers in NORFOLK | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.