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DSH490017AA Maryview Hospital LLC (Active)
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Main Details
Name
Maryview Hospital LLC
Subdivision Name
Bon Secours Liver Institute of Hamp - Hepatology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH490017AA
Medicare Provider Number
490017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/12/2018
Participating Start Date
4/1/2018
Participating Approval Date
2/13/2018
Last Recertification Date
8/23/2024
Contacts
Authorizing Official
Bon Secours Mercy Health
Jonathan Lee Haynes, Hampton Roads Market CFO
(540) 270-2809
Primary Contact
Bon Secours Mercy Health
Diana Willman, Pharmacy Director
(757) 398-2192
Addresses
Street Address
12720 McManus Blvd.
Ste 313
Newport News, VA 23602
Billing Address
Bon Secours Maryview Medical Center
3636 High Street
Portsmouth, VA 23707
Comments
Medicaid Billing
Shipping Addresses
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