NPIMap

Organization Active NPI

Halifax Regional Hospital, Inc

  • Skilled Nursing Facility
  • South Boston, VA
National Provider Identifier
1891786570
Registry record updated Jul 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
H1853 Issued in VA
Legal business name
HALIFAX REGIONAL HOSPITAL, INC
Practice address
2204 Wilborn Ave
South Boston, VA 24592-1645
Phone
(434) 517-3100
Fax
(434) 517-3819
NPI assigned
Nov 2, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2010

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

Authorized official

Name
Mrs. Stephanie Womack Elliott
Title
Coordinator Third Party Payers
Phone
(434) 517-3156

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X H1853 VA Primary

Addresses

Primary practice location

2204 Wilborn Ave
South Boston, VA 24592-1645

Mailing address

2204 Wilborn Ave
South Boston, VA 24592-1645
Phone (434) 517-3100

Other identifiers 4

IdentifierTypeStateIssuer
004952294MedicaidVA
8536228MedicaidVA
000054OtherVAANTHEM PROVIDER #
004900138MedicaidVA

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1130889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278547200000",
    "number": "1891786570",
    "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": "434-517-3100",
            "fax_number": "434-517-3819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2204 WILBORN AVE",
            "city": "SOUTH BOSTON",
            "state": "VA",
            "postal_code": "245921645",
            "telephone_number": "434-517-3100",
            "fax_number": "434-517-3819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HALIFAX REGIONAL HOSPITAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-02",
        "last_updated": "2010-07-08",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "WOMACK",
        "authorized_official_title_or_position": "COORDINATOR THIRD PARTY PAYERS",
        "authorized_official_telephone_number": "434-517-3156",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "H1853",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004952294",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8536228",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PROVIDER #",
            "identifier": "000054",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004900138",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Boston, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.