NPIMap

Organization Active NPI

Mary Immaculate Hospital LLC

Doing business as Bon Secours Palliative Medicine

  • Nurse Practitioner
  • Newport News, VA
National Provider Identifier
1568612265
Registry record updated Sep 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
MARY IMMACULATE HOSPITAL LLC
Doing business as
Bon Secours Palliative Medicine
Practice address
2 Bernardine Dr
Newport News, VA 23602-4404
Phone
(757) 947-3838
Fax
(757) 886-6757
NPI assigned
Sep 30, 2008
Last updated
Sep 21, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY IMMACULATE HOSPITAL LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 21, 2020

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

Authorized official

Name
Wilbur Gay
Title
Cfo
Phone
(864) 561-7672

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X NU Primary

Addresses

Primary practice location

2 Bernardine Dr
Newport News, VA 23602-4404

Mailing address

8580 Magellan Pkwy
Richmond, VA 23227-1149

Other names 1

  • BON SECOURS PALLIATIVE MEDICINE Doing business as

National Provider Directory

National Provider Directory
Part of
Invalid Entry

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Practitioners & affiliated clinicians

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.

NPI Registry JSON

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

{
    "created_epoch": "1222732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600646400000",
    "number": "1568612265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8580 MAGELLAN PKWY",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232271149",
            "fax_number": "866-449-0896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 BERNARDINE DR",
            "city": "NEWPORT NEWS",
            "state": "VA",
            "postal_code": "236024404",
            "telephone_number": "757-947-3838",
            "fax_number": "757-886-6757"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY IMMACULATE HOSPITAL LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY IMMACULATE HOSPITAL LLC",
        "enumeration_date": "2008-09-30",
        "last_updated": "2020-09-21",
        "certification_date": "2020-09-21",
        "status": "A",
        "authorized_official_last_name": "GAY",
        "authorized_official_first_name": "WILBUR",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "864-561-7672"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BON SECOURS PALLIATIVE MEDICINE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Newport News, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2020; 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.