DOMINION HEALTH MEDICAL ASSOC. (NPI# 1255771770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255771770 |
| Entity Type | Organization |
| Organization Name | DOMINION HEALTH MEDICAL ASSOC. |
| Other Organization Name | SENTORA HALIFAX GENERAL SURGERY |
| Practice Address |
2212 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 | 2013-06-28 |
| Last Update Date | 2015-02-10 |
| Authorized Official Name | CECIL HAZELWOOD (MANAGER (SDHG)) |
| Authorized Official Telephone | 4345173590 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Sentora Halifax General Surgery | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386737682 | Dominion Health Medical Assoc. | Legal Medicine | 15210 L. P. Bailey Memorial Hwy, South Boston, VA 24592 | 2006-10-02 |
| 1306150545 | Dominion Health Medical Assoc. | Orthopaedic Surgery | 422 Hamilton Blvd, South Boston, VA 24592 | 2010-07-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | DOMINION HEALTH MEDICAL ASSOCIATES LTD. | 2204 Wilborn Ave, South Boston, Virginia 24592 |
| Street Address |
2212 WILBORN AVE |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861472524 | Nonna Lyn M Ebalo | Pediatrics | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-01-19 |
| 1366814113 | Fuller Roberts Ob-gyn and Primary Care | Obstetrics & Gynecology | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2015-10-20 |
| 1316320187 | Cynthia Blanks Cole | Nurse Practitioner | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2015-06-29 |
| 1346553468 | Michelle Wilkens Helms | Specialist | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2010-07-18 |
| 1659317576 | Duc K Trieu | Obstetrics & Gynecology | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-06-20 |
| 1407891815 | Fuller-roberts Clinic, Inc | Pediatrics | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-06-19 |
| 1932178019 | Pamela Reynolds | Nurse Practitioner | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-03-14 |
| 1225006489 | William Allen Fuller Jr. | Surgery | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-03-14 |
| 1124097282 | Joan Wilson | Obstetrics & Gynecology | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-03-14 |
| 1427026806 | Prasit Thanaporn | Obstetrics & Gynecology | 2212 Wilborn Ave, South Boston, VA 24592-1630 | 2006-03-10 |
| 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 | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841815412 | Orthopaedic Surgery & Sports Med Specialist of Hampton Rds PC | Clinic/Center | 580 City Center Blvd, Newport News, VA 23606 | 2020-06-10 |
| 1093344210 | Virginia Womens Center for Aesthetics | Clinic/Center | 19490 Sandridge Way Ste 360, Leesburg, VA 20176-3467 | 2020-04-08 |
| 1306486634 | Fredericksburg Endoscopy Center, LLC | Clinic/Center | 1211 Central Park Blvd, Fredericksburg, VA 22401-4912 | 2020-01-15 |
| 1063058303 | Chesapeake Regional Surgery Center At Virginia Beach, LLC | Clinic/Center | 229 Clearfield Ave Ste 200, Virginia Beach, VA 23462-1815 | 2019-11-21 |
| 1154986347 | Center for Visual Surgical Excellence, LLC | Clinic/Center | 208 Carmichael Way, Chesapeake, VA 23322 | 2019-05-03 |
| 1720543481 | Surgical Suites of Coastal Virginia, LLC | Clinic/Center | 400 Sentara Cir Ste 200, Williamsburg, VA 23188-5716 | 2019-02-07 |
| 1962980045 | New Womens Health Charlottesville | Clinic/Center | 2050 Abbey Rd Ste D, Charlottesville, VA 22911-3553 | 2018-08-01 |
| 1518450790 | Virginia Ent Surgery Center Inc | Clinic/Center | 6600 W Broad St Ste 210, Richmond, VA 23230-1709 | 2018-06-12 |
| 1336649714 | Healthqare Services Asc LLC | Clinic/Center | 1005 N Glebe Rd Ste 200, Arlington, VA 22201-5792 | 2018-02-13 |
| 1104349489 | Valley Health Surgery Center, LLC | Clinic/Center | 174 Botanical Boulevard, Winchester, VA 22603 | 2017-07-19 |
| 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.