DOMINION HEALTH MEDICAL ASSOC (NPI# 1134407570) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134407570 |
| Entity Type | Organization |
| Organization Name | DOMINION HEALTH MEDICAL ASSOC |
| Other Organization Name | SENTARA HALIFAX EMERGENCY PHYSICIAL |
| Practice Address |
2204 Wilborn Ave South Boston VA 24592 |
| Mailing Address |
P.o. Box 860 South Boston VA 24592 |
| Practice Telephone | 4345173529 |
| Practice Fax Number | 4345173887 |
| Mailing Telephone | 4345173513 |
| Mailing Fax Number | 4345173887 |
| Enumeration Date | 2011-08-03 |
| Last Update Date | 2015-02-10 |
| Authorized Official Name | CECIL HAZELWOOD (MANAGER DHMA) |
| Authorized Official Telephone | 4345173515 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0002X |
Clinic/Center Specialization: Emergency Care |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Sentara Halifax Emergency Physicial | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407051873 | Dominion Health Medical Assoc | Legal Medicine | 101 Aubrey's Loop Rd, South Boston, VA 24592 | 2007-06-18 |
| 1669572897 | Dominion Health Medical Assoc | Legal Medicine | 115 College St, Clarksville, VA 23927 | 2006-09-25 |
| 1689772238 | Dominion Health Medical Assoc | Legal Medicine | 946 N. Main St, Chase City, VA 23924 | 2006-09-20 |
| 1568933182 | Dominion Health Medical Assoc | Clinic/Center | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2018-12-07 |
| 1457756322 | Dominion Health Medical Assoc | Pediatrics | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2014-11-04 |
| 1427306315 | Dominion Health Medical Assoc | Specialist | 2232 Wilborn Ave, Suite F, South Boston, VA 24592 | 2012-08-27 |
| 1760740625 | Dominion Health Medical Assoc | Clinic/Center | 2206 Wilborn Ave, South Boston, VA 24592 | 2012-04-30 |
| 1639457179 | Dominion Health Medical Assoc | Anesthesiology | 2204 Wilborn Ave, South Boston, VA 24592 | 2011-08-02 |
| 1598928277 | Dominion Health Medical Assoc | Legal Medicine | 2232 Wilborn Ave, Suite C, South Boston, VA 24592 | 2008-07-03 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | DOMINION HEALTH MEDICAL ASSOCIATES LTD. | 2204 Wilborn Ave, South Boston, Virginia 24592 |
| Street Address |
2204 WILBORN AVE |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588668842 | Halifax Regional Hospital, Inc. | General Acute Care Hospital | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2005-06-02 |
| 1871058008 | Angeline Marie Davis | Nurse Anesthetist, Certified Registered | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2019-02-01 |
| 1063931897 | Jon Michael Hughes | Nurse Practitioner | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2017-09-13 |
| 1265950646 | Mara Olivia Fiorio | Dietitian, Registered | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2017-09-06 |
| 1942745526 | Alisyn L. Metz | Nurse Anesthetist, Certified Registered | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2017-01-05 |
| 1255876835 | Andrew D. Metz | Nurse Anesthetist, Certified Registered | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2017-01-05 |
| 1942743398 | Melaku Akele | Physical Therapist | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2016-12-01 |
| 1740730316 | Emily Silsby | Dietitian, Registered | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2016-10-07 |
| 1023567153 | Mulbriar Emergency Physicians LLC | Physician Assistant | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2016-09-30 |
| 1205381621 | Banister River Emergency Physicians LLC | Physician Assistant | 2204 Wilborn Ave, South Boston, VA 24592-1645 | 2016-08-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154966398 | Transformations Center for Health Wellness LLC | Counselor | 2170 Sandy Beach Road, South Boston, VA 24592 | 2019-11-12 |
| 1740830215 | Kirstyn Lokker | Occupational Therapist | 1 High School Circle, South Boston, South Boston, VA 24592 | 2019-09-17 |
| 1841764248 | Nicole Ivey | Occupational Therapy Assistant | 103 Rosehil Rd, South Boston, VA 24592 | 2019-01-18 |
| 1841700960 | Bio-medical Applications of Virginia, Inc. | Clinic/Center | 130 Aubreys Loop, South Boston, VA 24592 | 2017-10-03 |
| 1659828820 | Family Preservation Services, Inc | Community/Behavioral Health | 1 High School Circle, South Boston, VA 24592 | 2016-09-06 |
| 1316222821 | Family and Children Enrichment Services Inc. | Health Maintenance Organization | 220 Paradise Lane, South Boston, VA 24592 | 2011-10-15 |
| 1326365578 | Brinda Howard | Nurse's Aide | 104 Love Shop Park Rd Lot #25, South Boston, VA 24592 | 2010-04-28 |
| 1356513543 | Betts Medical Supplies, LLC. | Durable Medical Equipment & Medical Supplies | 403 Factory Street, Suite B, South Boston, VA 24592 | 2008-03-27 |
| 1407051873 | Dominion Health Medical Assoc | Legal Medicine | 101 Aubrey's Loop Rd, South Boston, VA 24592 | 2007-06-18 |
| 1437352945 | Behavioral Health Associates, Inc. | Non-emergency Medical Transport (VAN) | 515 Yancey Ave, South Boston, VA 24592 | 2007-06-11 |
| Find all providers in zip 24592 | ||||
| Taxonomy Code | 261QE0002X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Emergency Care |
| Definition to come... |
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| 1407286289 | Reston Hospital Center, LLC | Clinic/Center | 24570 Gum Spring Rd, Dulles, VA 20166-2246 | 2013-11-15 |
| 1750711537 | Hca Health Services of Virginia, Inc. | Clinic/Center | 12720 Tuckahoe Creek Pkwy, Richmond, VA 23238-1121 | 2013-11-15 |
| 1972936110 | Virginia Urgent and Emergent Medical Support | Clinic/Center | 9702 Gayton Rd Ste 256, Henrico, VA 23238-4907 | 2013-08-12 |
| 1306120175 | Bon Secours St. Francis Medical Center Inc | Clinic/Center | 601 Watkins Centre Pkwy Ste 100, Midlothian, VA 23114-4412 | 2011-09-28 |
| 1003037227 | Children's National Medical Center | Clinic/Center | 1201 S Eads St, #1808, Arlington, VA 22202-2812 | 2007-05-02 |
| 1588298368 | Virginia Commonwealth University Health System Authority | Clinic/Center | 2495 Pocahontas Trl, Quinton, VA 23141-1637 | 2020-03-02 |
| 1588210108 | Riverside Physician Services Inc | Clinic/Center | 500 J Clyde Morris Blvd, Newport News, VA 23601-1929 | 2019-08-12 |
| Find all providers with the same taxonomy | ||||
| City | SOUTH BOSTON |
| Zip Code | 24592 |
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| 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.