Provider Demographics
NPI:1356531891
Name:MARYVIEW HOSPITAL
Entity type:Organization
Organization Name:MARYVIEW HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:4037 TAYLOR RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23321-5535
Mailing Address - Country:US
Mailing Address - Phone:757-484-2272
Mailing Address - Fax:757-484-4620
Practice Address - Street 1:4037 TAYLOR RD
Practice Address - Street 2:SUITE C
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23321-5535
Practice Address - Country:US
Practice Address - Phone:757-484-2272
Practice Address - Fax:757-484-4620
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARYVIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-07-31
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05403Medicare PIN
VACD1008Medicare PIN