NPIMap

Organization Active NPI

Halifax Regional Hospital, Inc

Doing business as Sentara Halifax Pediatrics

  • Rural Health Clinic/Center
  • South Boston, VA
National Provider Identifier
1841809241
Registry record updated Dec 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
HALIFAX REGIONAL HOSPITAL, INC
Doing business as
Sentara Halifax Pediatrics
Practice address
2100 Wilborn Ave
South Boston, VA 24592-1628
Phone
(434) 517-8022
NPI assigned
Jul 31, 2020
Last updated
Dec 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2025

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

Authorized official

Name
Melinda Summerlin Hancock
Title
Cfo
Phone
(757) 455-7458

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

2100 Wilborn Ave
South Boston, VA 24592-1628

Mailing address

2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (757) 455-7395

Other names 1

  • Sentara Halifax Pediatrics Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201113000602 VA Part A Provider - Other 4587572805 Practice locations: South Boston, VA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1841809241. Details of each certification follow.

Rural health clinic certification: CCN 493457

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
SENTARA HALIFAX PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 31, 2021
Last certification
Mar 31, 2021
Ownership / control type
2B
Facility address
2100 Wilborn Avenue
South Boston, VA 24592
Related CCNs
490013

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D2087553Sentara Halifax Pediatrics2100 Wilborn Avenue, South Boston, VA 24592Certificate of waiverNov 27, 2026

National Provider Directory

National Provider Directory
Tax ID family
Halifax So Bos Com Co a8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1596153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765411200000",
    "number": "1841809241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "757-455-7395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921628",
            "telephone_number": "434-517-8022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALIFAX REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-31",
        "last_updated": "2025-12-11",
        "certification_date": "2025-12-11",
        "status": "A",
        "authorized_official_last_name": "HANCOCK",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "SUMMERLIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "757-455-7458"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sentara Halifax Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in South Boston, VA

Sources for this page

Verify at the official NPI Registry.