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General NPI Number Information
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NPI Number | 1427064310
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Entity Type | Organization
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Legal Business Name | MARY IMMACULATE HOSPITAL LLC
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 08/27/2020
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Provider Practice Location Address
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Address Line | 2 BERNARDINE DR
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City | NEWPORT NEWS
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State | VA
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Zip | 23602-4404
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Country | US
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Telephone | 757-886-6500
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Fax | 757-886-6539
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Provider Business Mailing Address
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Address Line | PO BOX 639899
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City | CINCINNATI
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State | OH
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Zip | 45263-9899
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Country | US
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Telephone | 804-627-5462
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Fax | 866-449-0896
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Authorized Official
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Title or Position | SYSTEM DIRECTOR PAYOR ADMIN
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Name | KIMBERLY M RALSTON
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Credential |
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Telephone | 419-996-5119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | H 1873
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License Number State | VA
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