Halifax Regional Hospital, Inc
Organization Active NPI Rural Health Clinic/Center · South Boston, VA
NPI 1033728803 · NPPES record last updated Dec 11, 2025
Key facts
- NPI
- 1033728803
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rural Health Clinic/Center 261QR1300X
- Legal business name
- HALIFAX REGIONAL HOSPITAL, INC
- Practice address
- 2206 Wilborn Ave
Medical Office Building #1
South Boston, VA 24592 - Phone
- (434) 517-8627
- NPI assigned
- Jul 28, 2020
- Organization subpart
- No
Authorized official
- Name
- Melinda Summerlin Hancock
- Title
- Cfo
- Phone
- (757) 455-7458
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 7
Practitioners 44
-
Joni Abbott, D.O.
-
Keysha D. Ahmad-Winborne, FNP-BC
-
Maggie Ford Bane, NP-C
-
Paul S Buckman, MD
-
Laura I Castle, LPC CSAC
-
Janet Holt Durham, FNP-BC
-
Laura Hamlette, MS, LPC, CSAC
-
Jacob Hudson, LPC
-
Parker L Jamieson, PA-C
-
Victor Mihal, D.O.
-
Alyssa N Milam, FNP-C
-
Corin Kelly Miller, FNP
-
Jessica Driggs Ruff, FNP-C
-
Pablo Cesar Souza, M.D.
-
Colton Ryan Thames, FNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040607000050 | VA | Part B Supplier - Clinic/Group Practice | 4587572805 |
Receives reassigned benefits from 45 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Nathalie, VA; South Boston, VA; Clarksville, VA; Chase City, VA |
| O20201112003144 | VA | Part a Provider - Other | 4587572805 | Practice locations: South Boston, VA |
National Provider Directory
- Tax ID family
- Halifax-So Boston Comm
Locations
15210 L P Bailey Memorial Hwy
Nathalie, VA 24577
Phone (434) 349-3113
2232 Wilborn Ave
Ste E
South Boston, VA 24592
Phone (434) 517-3169
2206 Wilborn Ave
Ofc
South Boston, VA 24592
Phone (434) 517-8627
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rural Health Clinic/Center | 261QR1300X | Yes |
Addresses
Primary practice location
2206 Wilborn Ave
Medical Office Building #1
South Boston, VA 24592
Mailing address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (757) 455-7395
Other practice location 1
101 Aubreys Loop
South Boston, VA 24592-5056
Phone (434) 517-8627
Other names
- Sentara Gynecology Specialists
Other providers in South Boston, VA
- Halifax Medical Equipment, Inc
- Halifax Radiological Associates, Inc.
- Halifax Regional Hospital
- Halifax Regional Hospital
- Halifax Regional Hospital, Inc
- Halifax Regional Hospital, Inc
- Halifax Regional Hospital, Inc
- Halifax Regional Hospital, Inc.
- Halifax Regional Hospital, Inc.
- Halifax Regional Hospital, Inc.
All providers in South Boston, VA · Rural Health Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 11, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.