1518969617 NPI number — MARYVIEW HOSPITAL, LLC

Table of content: (NPI 1518969617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518969617 NPI number — MARYVIEW HOSPITAL, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARYVIEW HOSPITAL, LLC
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 HOME CARE
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:
1518969617
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7007 HARBOUR VIEW BLVD STE 114
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:
23435-3657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-889-4663
Provider Business Practice Location Address Fax Number:
757-393-4762
Provider Enumeration Date:
06/02/2005

Additional Information

			
		

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , 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: 231526 . This is a "MAMSI, OPTIMUM, GEHA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 001801 . This is a "ANTHEM BLUE CROSS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 26198 . This is a "SENTARA, OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4972457 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148668900 . This is a "WORKMANS COMP" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".