Provider Demographics
NPI:1942230958
Name:MARYVIEW HOSPITAL
Entity Type:Organization
Organization Name:MARYVIEW HOSPITAL
Other - Org Name:BON SECOURS MEDCARE CHURCHLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:A
Authorized Official - Last Name:SIMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-673-5928
Mailing Address - Street 1:5615 HIGH ST W # A
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23703-3758
Mailing Address - Country:US
Mailing Address - Phone:757-484-5002
Mailing Address - Fax:757-483-9605
Practice Address - Street 1:5615 HIGH ST W # A
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-3758
Practice Address - Country:US
Practice Address - Phone:757-484-5002
Practice Address - Fax:757-483-9605
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-04
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD1008Medicare PIN
VAC05144Medicare PIN