DOMINION HEALTH MEDICAL ASSOC (NPI# 1568933182) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568933182 |
| Entity Type | Organization |
| Organization Name | DOMINION HEALTH MEDICAL ASSOC |
| Practice Address |
101 Aubreys Loop South Boston VA 24592-5054 |
| Mailing Address |
Po Box 860 South Boston VA 24592-0860 |
| Practice Telephone | 4345173879 |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2018-12-07 |
| Authorized Official Name | CECIL HAZELWOOD (MANAGER) |
| Authorized Official Telephone | 4345173515 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QX0100X |
Clinic/Center Specialization: Occupational Medicine |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Sentara Occupational Medicine | 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 |
| 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 |
| 1134407570 | Dominion Health Medical Assoc | Clinic/Center | 2204 Wilborn Ave, South Boston, VA 24592 | 2011-08-03 |
| 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 |
101 AUBREYS LOOP |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592-5054 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770551889 | Broderick Daryl King | Internal Medicine | 101 Aubreys Loop, South Boston, VA 24592-5056 | 2006-03-14 |
| 1023627486 | Halifax Regional Hospital, Inc | Clinic/Center | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2020-07-30 |
| 1154828168 | Jean Minier | Registered Nurse | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2018-04-07 |
| 1649702358 | Ronald Pryor | Nurse Practitioner | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2017-03-31 |
| 1013469204 | Whitney Heather Rae Wilborn | Nurse Practitioner | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2016-11-04 |
| 1760832372 | Devmith Chinthaka Gajadeera | Internal Medicine | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2016-06-14 |
| 1245636208 | Angelin Barker Comer | Nurse Practitioner | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2014-11-18 |
| 1457756322 | Dominion Health Medical Assoc | Pediatrics | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2014-11-04 |
| 1932527355 | Virgilus Ozoude | Family Medicine | 101 Aubreys Loop, South Boston, VA 24592-5054 | 2014-04-02 |
| 1063844926 | Amanda Igata | Nurse Practitioner | 101 Aubreys Loop, South Boston, VA 24592-5056 | 2013-08-02 |
| 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 | 261QX0100X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Occupational Medicine |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851591101 | Rehabcare | Clinic/Center | 1051j Village Hwy, Suite J, Rustburg, VA 24588-3800 | 2007-07-24 |
| 1023219904 | Community Physicians Services Corporation | Clinic/Center | 1418 Park Ave Nw, Norton, VA 24273-1602 | 2007-05-30 |
| 1336282268 | Taylor Made Diagnostics Inc. | Clinic/Center | 1001 Poindexter St, Chesapeake, VA 23324-2444 | 2007-02-14 |
| 1841383866 | Grady Health Services Inc. | Clinic/Center | 7524 Diplomat Dr, Manassas, VA 20109-2685 | 2006-10-02 |
| 1154342160 | Imed, Inc. | Clinic/Center | 838 Old George Washington Hwy N, Suite A, Chesapeake, VA 23323-2209 | 2006-07-22 |
| 1497114169 | Genesis Healthcare | Clinic/Center | 803 S Main St, Woodstock, VA 22664-1125 | 2016-02-23 |
| 1508245648 | Anna Nicole Kostal | Clinic/Center | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2015-05-21 |
| 1982009593 | Working Well, LLC | Clinic/Center | 4835 S Laburnum Ave, Richmond, VA 23231-2713 | 2014-10-24 |
| 1629482526 | Occupational Health Services | Clinic/Center | 607 E Jubal Early Dr, Winchester, VA 22601-5178 | 2014-06-18 |
| 1124438627 | Blue Ridge Medical Management Corporation | Clinic/Center | 245 Medical Park Dr, Suite C, Marion, VA 24354-1100 | 2014-05-06 |
| 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.