# MARY IMMACULATE HOSPITAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARY IMMACULATE HOSPITAL LLC
- **Other names:** BON SECOURS PALLIATIVE MEDICINE
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1568612265
- **Legal business name:** MARY IMMACULATE HOSPITAL LLC
- **Authorized official:** WILBUR GAY (CFO)
- **Authorized official phone:** (864) 561-7672

## Contact information

- **Practice address:** 2 BERNARDINE DR, NEWPORT NEWS, VA 23602-4404
- **Practice address phone:** (757) 947-3838
- **Practice address fax:** (757) 886-6757
- **Mailing address:** 8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
- **Mailing address fax:** (866) 449-0896

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | — | NULL | Yes |
| 363L00000X | Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 09/30/2008
- **Last updated:** 09/21/2020