1992724033 NPI number — HALIFAX REGIONAL HOSPITAL

Table of content: (NPI 1992724033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992724033 NPI number — HALIFAX REGIONAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HALIFAX REGIONAL HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SENTARA HALIFAX REGIONAL HOSPITAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992724033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2204 WILBORN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH BOSTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24592-1645
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-517-3100
Provider Business Mailing Address Fax Number:
434-575-0377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 WILBORN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTH BOSTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24592-1645
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-517-3100
Provider Business Practice Location Address Fax Number:
434-575-0377
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELLIOTT
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
W
Authorized Official Title or Position:
COORDINATOR THIRD PARTY PAYERS
Authorized Official Telephone Number:
434-517-3156

Provider Taxonomy Codes

  • Taxonomy code: 246Q00000X , with the licence number:  H1853 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246W00000X , with the licence number: H1853 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: H1853 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 005831300 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006041736 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006072097 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006604510 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010053871 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010110041 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005802334 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005810922 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010263867 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006017738 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006081011 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005875251 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006089526 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 005828902 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006086675 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006087701 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007306628 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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