MEDICARE: HALIFAX HOSPITAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency	4181	FL
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	4181	FL
3	273R00000X	Psychiatric Hospital Unit	4181	FL
4	273Y00000X	Rehabilitation Hospital Unit	4181	FL
5	282N00000X	General Acute Care Hospital	4181	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	303	OTHER	FL	BLUE CROSS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811991227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HALIFAX HOSPITAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	303 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	386-425-4000
Fax Number	:

Provider Business Practice Location Address
First Line	:	303 N CLYDE MORRIS BLVD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2709
Country	:	US
Telephone Number	:	386-254-4000
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	ERIC M PEBURN
Credential	:
Telephone Number	:	386-425-4568

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	01/14/2021

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Directions to “HALIFAX HOSPITAL MEDICAL CENTER ” Practice Location

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