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General NPI Number Information
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NPI Number | 1538535463
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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 | 08/14/2015
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Last Update Date | 09/21/2020
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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 | 757-398-2208
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Fax | 757-398-2004
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Provider Business Mailing Address
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Address Line | 8580 MAGELLAN PKWY
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City | RICHMOND
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State | VA
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Zip | 23227-1149
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Country | US
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Telephone |
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Fax | 866-449-0896
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Authorized Official
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Title or Position | CFO
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Name | WILBUR GAY
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Credential |
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Telephone | 864-561-7672
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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 |
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License Number State |
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