Mary Immaculate Hospital

Primary specialty

Hospice and Palliative Medicine (Obstetrics & Gynecology) PhysicianTaxonomy code 207VH0002X

Legal business name

MARY IMMACULATE HOSPITAL

Doing business as

Dba Bon Secours Palliative Medicine

Practice address

12720 McManus Blvd
Suite 301
Newport News, VA 23602-4414

Phone

(757) 947-3838

Fax

(757) 327-4280

NPI assigned

Nov 7, 2016

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karen Smith

Title

Credentialing Specialist

Phone

(757) 215-2784

Specialties & licenses 1

Addresses

Other names 1

• DBA BON SECOURS PALLIATIVE MEDICINE Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Susan Christine Clark, MD

  • Surgery Physician
  • Portsmouth, VA
  • NPI 1104096650
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1478476800000",
    "number": "1194267229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7007 HARBOUR VIEW BLVD",
            "address_2": "SUITE 108",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234353657",
            "telephone_number": "757-215-2784",
            "fax_number": "757-215-2728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12720 MCMANUS BLVD",
            "address_2": "SUITE 301",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024414",
            "telephone_number": "757-947-3838",
            "fax_number": "757-327-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY IMMACULATE HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-07",
        "last_updated": "2016-11-07",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KAREN",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "757-215-2784"
    },
    "taxonomies": [
        {
            "code": "207VH0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology, Hospice and Palliative Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DBA BON SECOURS PALLIATIVE MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary C Burch PSYD PC
• Mary Immaculate Ambulatory Surgery Center LLC
• Mary Immaculate Hospital (Cardiovascular Specialists)
• Mary Immaculate Hospital
• Mary Immaculate Hospital (Bon Secours Occumed Center)
• Mary Immaculate Hospital (Bon Secours Pulmonary Specialists @ MIH)
• Mary Immaculate Hospital (Dba Bon Secours Vein and Vascular Specialists @ Mih)
• Mary Immaculate Hospital (Vascular Surgery)
• Mary Immaculate Hospital LLC (Bon Secours Surgical Specialists)
• Mary Immaculate Hospital LLC

• Obstetrics & Gynecology Physician in Newport News, VA
• Providers in Newport News, VA by specialty
• Obstetrics & Gynecology Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.