# MARY IMMACULATE HOSPITAL

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DBA BON SECOURS PALLIATIVE MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194267229
- **Authorized official:** KAREN SMITH (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (757) 215-2784

## Contact information

- **Practice address:** 12720 MCMANUS BLVD, SUITE 301, NEWPORT NEWS, VA 23602-4414
- **Practice address phone:** (757) 947-3838
- **Practice address fax:** (757) 327-4280
- **Mailing address:** 7007 HARBOUR VIEW BLVD, SUITE 108, SUFFOLK, VA 23435-3657
- **Mailing address phone:** (757) 215-2784
- **Mailing address fax:** (757) 215-2728

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207VH0002X | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician | — | NULL | Yes |
| 207VH0002X | Hospice and Palliative Medicine (Obstetrics & Gynecology) Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/07/2016
- **Last updated:** 11/07/2016