Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days.
Organization
MARY IMMACULATE AMBULATORY SURGERY CENTER LLC
Active
Organization
MARY IMMACULATE AMBULATORY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTEN OCONNOR (AUTHORIZED OFFICIAL)
(615) 376-7315
Entity
Organization
Contact information
Practice address
12720 MCMANUS BLVD, STE 103, NEWPORT NEWS, VA 23602-4441
(757) 369-7000
(757) 369-3465
Mailing address
12720 MCMANUS BLVD, STE 103, NEWPORT NEWS, VA 23602-4441
(757) 369-7000
(757) 369-3465
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
OH686
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010113181
—
VA
01
—
P00165787
MEDICARE RAILROAD
VA
Enumeration date
07/04/2006
Last updated
10/11/2024
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up