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General NPI Number Information
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NPI Number | 1457482531
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Entity Type | Organization
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Legal Business Name | HALIFAX MEDICAL SERVICES PA
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 07/08/2008
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Provider Practice Location Address
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Address Line | 105 SOUTHWEST FIRST STREET
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City | PINETOPS
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State | NC
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Zip | 27864
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Country | US
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Telephone | 252-827-1550
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Fax |
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Provider Business Mailing Address
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Address Line | 105-C SOUTHWEST FIRST ST PO BOX 685
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City | PINETOPS
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State | NC
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Zip | 27864
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN HUME FAULKNER
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Credential | PA-C,MPH
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Telephone | 252-827-1550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 68222
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License Number State | NC
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