Healthcare Provider Details

I. General information

NPI: 1861565731
Provider Name (Legal Business Name): HALIFAX REGIONAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 WILBORN AVE
SOUTH BOSTON VA
24592-1645
US

IV. Provider business mailing address

2204 WILBORN AVE
SOUTH BOSTON VA
24592-1645
US

V. Phone/Fax

Practice location:
  • Phone: 434-517-3100
  • Fax: 434-517-3819
Mailing address:
  • Phone: 434-517-3100
  • Fax: 434-517-3819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberH1853
License Number StateVA

VIII. Authorized Official

Name: MRS. STEPHANIE ELLIOTT
Title or Position: COORDINATOR THIRD PARTY PAYORS
Credential:
Phone: 434-517-3156