DOMINION HEALTH MEDICAL ASSOC (NPI# 1760740625) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760740625 |
| Entity Type | Organization |
| Organization Name | DOMINION HEALTH MEDICAL ASSOC |
| Other Organization Name | SENTARA HALIFAX NEUROLOGY |
| Practice Address |
2206 Wilborn Ave South Boston VA 24592 |
| Mailing Address |
P.o. Box 860 South Boston VA 24592 |
| Practice Telephone | 4345178075 |
| Practice Fax Number | 4345173887 |
| Mailing Telephone | 4345173513 |
| Mailing Fax Number | 4345173887 |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2015-02-10 |
| Authorized Official Name | CECIL HAZELWOOD (MANAGER (SDHG)) |
| Authorized Official Telephone | 4345173515 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 0101251410 | VA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | LICENSE | 0101251410 | 01 |
| Other Name | Type Code |
|---|---|
| Sentara Halifax Neurology | 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 |
| 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 |
2206 WILBORN AVE |
| City | SOUTH BOSTON |
| State | VA |
| Zip Code | 24592 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962420166 | Charles William Rosche | Specialist | 2206 Wilborn Ave, South Boston, VA 24592-1630 | 2006-07-17 |
| 1033728803 | Halifax Regional Hospital, Inc | Clinic/Center | 2206 Wilborn Ave, Medical Office Building #1, South Boston, VA 24592 | 2020-07-28 |
| 1992244172 | Dominion Health Medical Associates Ltd | Clinic/Center | 2206 Wilborn Ave, South Boston, VA 24592 | 2017-02-21 |
| 1407308703 | University of North Carolina At Chapel Hill | Neurological Surgery | 2206 Wilborn Ave, Suite One, South Boston, VA 24592-1630 | 2016-11-03 |
| 1972861169 | Maggie Ford Bane | Nurse Practitioner | 2206 Wilborn Ave, South Boston, VA 24592-1630 | 2012-04-25 |
| 1215294814 | Joni Abbott | Obstetrics & Gynecology | 2206 Wilborn Ave, South Boston, VA 24592-1630 | 2012-04-19 |
| 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 | 261Q00000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| A facility or distinct part of one used for the diagnosis and treatment of outpatients. "Clinic/Center" is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972004299 | Velocity Urgent Care, LLC | Clinic/Center | 3601 Old Halifax Rd, South Boston, VA 24592-4952 | 2018-02-22 |
| 1801175567 | Dominion Health Medical Associates | Clinic/Center | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2011-08-12 |
| 1396079414 | Gavin Foundation | Clinic/Center | 49 L St, South Boston, MA 02127-1511 | 2009-09-22 |
| 1366626624 | South Boston Community Health Center | Clinic/Center | 409 W Broadway, South Boston, MA 02127-2245 | 2007-12-21 |
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| 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.