Basic Information
| Provider Information | |||||||||
| NPI: | 1316482318 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MARYVIEW HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BON SECOURS GREENBRIER BEHAVIORAL HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 908 EDEN WAY N | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233203336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577381350 | ||||||||
| FaxNumber: | 7574135450 | ||||||||
| Practice Location | |||||||||
| Address1: | 908 EDEN WAY N | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | CHESAPEAKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 233203336 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7577381350 | ||||||||
| FaxNumber: | 7574135450 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2016 | ||||||||
| LastUpdateDate: | 02/15/2019 | ||||||||
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| AuthorizedOfficialLastName: | QUIRICONI | ||||||||
| AuthorizedOfficialFirstName: | STEPHAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 8042818301 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.