Organization
MARY IMMACULATE HOSPITAL LLC
Active
Parent organization
MARY IMMACULATE HOSPITAL LLC
Other names
BON SECOURS PALLIATIVE MEDICINE
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY IMMACULATE HOSPITAL LLC
Authorized official
WILBUR GAY (CFO)
(864) 561-7672
Entity
Organization
Contact information
Practice address
2 BERNARDINE DR, NEWPORT NEWS, VA 23602-4404
(757) 947-3838
(757) 886-6757
Mailing address
8580 MAGELLAN PKWY, RICHMOND, VA 23227-1149
(866) 449-0896
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
09/30/2008
Last updated
09/21/2020
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