Organization
MARYVIEW HOSPITAL LLC
Active
Other names
Bon Secours Liver Institute of Hampton Roads
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY M RALSTON (SYSTEM DIRECTOR)
(419) 996-5119
Entity
Organization
Contact information
Practice address
12720 MCMANUS BLVD STE 313, NEWPORT NEWS, VA 23602-4414
(757) 947-3190
(757) 947-3195
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(804) 627-5462
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C05149
MEDICARE PTAN
VA
Enumeration date
07/13/2017
Last updated
11/04/2024
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