Healthcare Provider Details

I. General information

NPI: 1275656118
Provider Name (Legal Business Name): HALIFAX REGIONAL MEDICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 A SMITH CHURCH ROAD
ROANOKE RAPIDS NC
27870-4942
US

IV. Provider business mailing address

210 A SMITH CHURCH RD
ROANOKE RAPIDS NC
27870-4942
US

V. Phone/Fax

Practice location:
  • Phone: 252-535-8463
  • Fax: 252-535-8137
Mailing address:
  • Phone: 252-535-8463
  • Fax: 252-535-8137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHERRY E JENSEN
Title or Position: VP FINANCE
Credential:
Phone: 252-535-8005