1053557793 NPI number — MARYVIEW HOSPITAL

Table of content: (NPI 1053557793)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053557793 NPI number — MARYVIEW HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYVIEW HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BON SECOURS HEALTH CENTER AT HARBOUR VIEW
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053557793
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/31/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3636 HIGH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTSMOUTH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23707-3236
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-398-2200
Provider Business Mailing Address Fax Number:
757-398-2359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5818 HARBOUR VIEW BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUFFOLK
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23435-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-673-5800
Provider Business Practice Location Address Fax Number:
757-673-5868
Provider Enumeration Date:
12/31/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SIMIA
Authorized Official First Name:
GREG
Authorized Official Middle Name:
A
Authorized Official Title or Position:
VP / CFO
Authorized Official Telephone Number:
757-673-5928

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  H 1830 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 307891 . This is a "ANTHEM ED" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 227100 . This is a "ANTHEM OTHER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com