MEDICARE: MARYVIEW HOSPITAL, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency		VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231526	OTHER	VA	MAMSI, OPTIMUM, GEHA
2	001801	OTHER	VA	ANTHEM BLUE CROSS
3	26198	OTHER	VA	SENTARA, OPTIMA
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	148668900	OTHER	VA	WORKMANS COMP

General Provider Information

NPI Number	:	1518969617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYVIEW HOSPITAL, LLC

Provider Business Mailing Address
First Line	:	PO BOX 639898
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45263-9898
Country	:	US
Telephone Number	:	513-952-5002
Fax Number	:

Provider Business Practice Location Address
First Line	:	7007 HARBOUR VIEW BLVD STE 114
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23435-3657
Country	:	US
Telephone Number	:	757-889-4663
Fax Number	:	757-393-4762

Authorized Official
Title or Position	:	VP REIMBURSEMENT
Name	:	KIMBERLY M RALSTON
Credential	:
Telephone Number	:	419-996-5119

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	09/20/2023

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