BOYDTON COMMUNITY HEALTH FACILITY INC (NPI# 1023233905) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023233905 |
| Entity Type | Organization |
| Organization Name | BOYDTON COMMUNITY HEALTH FACILITY INC |
| Other Organization Name | HALIFAX FAMILY HEALTH CENTER PHYSICIAN PAVILLION |
| Practice Address |
2232 Wilborn Ave South Boston VA 24592-1662 |
| Practice Telephone | 4345724378 |
| Practice Fax Number | 4345724730 |
| Mailing Telephone | 4345724378 |
| Mailing Fax Number | 4345724730 |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2009-07-24 |
| Authorized Official Name | ANGELA N MILLER (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 4347386102 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QF0400X |
Clinic/Center Specialization: Federally Qualified Health Center (FQHC) |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | 007691092 | 05 |
| Other Name | Type Code |
|---|---|
| Halifax Family Health Center Physician Pavillion | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023340825 | Boydton Community Health Facility Inc | Pharmacy | 390 Washington St, Boydton, VA 23917-3415 | 2010-02-03 |
| 1114184546 | Boydton Community Health Facility Inc | Clinic/Center | 1329 Jefferson Street, Boydton, VA 23917 | 2008-05-22 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | BOYDTON COMMUNITY HEALTH FACILITY INC. | 982 Jefferson Street, Po Box 382, Boydton, Virginia 23917 |
| Street Address |
2232 WILBORN AVE |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592-1662 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700881885 | Tessie Otero-truitt | Internal Medicine | 2232 Wilborn Ave, Ste B, South Boston, VA 24592-1662 | 2005-06-16 |
| 1225658206 | Brandi S Thompson | Nurse Practitioner | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2020-04-20 |
| 1588189609 | Allison Newbill Pope | Nurse Practitioner | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2017-08-09 |
| 1619370087 | Anthony Wilkerson | Nurse Practitioner | 2232 Wilborn Ave, Suite A, South Boston, VA 24592-1662 | 2014-09-30 |
| 1962744508 | Whitney A Myers | Nurse Practitioner | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2013-03-21 |
| 1285970236 | Katherine Gambino | Physician Assistant | 2232 Wilborn Ave, Suite G, South Boston, VA 24592-1662 | 2012-12-19 |
| 1427306315 | Dominion Health Medical Assoc | Specialist | 2232 Wilborn Ave, Suite F, South Boston, VA 24592 | 2012-08-27 |
| 1730455411 | Dominion Medical Health Assoc | Internal Medicine | 2232 Wilborn Ave, Suite D, South Boston, VA 24592 | 2012-03-28 |
| 1801175567 | Dominion Health Medical Associates | Clinic/Center | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2011-08-12 |
| 1316267750 | Gareth Murchison Titus | Specialist | 2232 Wilborn Ave, Suite A, South Boston, VA 24592-1662 | 2010-06-08 |
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| 1841764248 | Nicole Ivey | Occupational Therapy Assistant | 103 Rosehil Rd, South Boston, VA 24592 | 2019-01-18 |
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| Taxonomy Code | 261QF0400X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Federally Qualified Health Center (FQHC) |
| Definition to come... |
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| City | SOUTH BOSTON |
| Zip Code | 24592 |
Please comment or provide details below to improve the information on BOYDTON COMMUNITY HEALTH FACILITY INC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.