DOMINION HEALTH MEDICAL ASSOCIATES (NPI# 1801175567) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1801175567 |
| Entity Type | Organization |
| Organization Name | DOMINION HEALTH MEDICAL ASSOCIATES |
| Other Organization Name | HALIFAX UROLOGY ASSOCIATES |
| Practice Address |
2232 Wilborn Ave South Boston VA 24592-1662 |
| Mailing Address |
Po Box 777 South Boston VA 24592-0777 |
| Practice Telephone | 4345173100 |
| Mailing Telephone | 4345173513 |
| Mailing Fax Number | 4345724549 |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2011-08-12 |
| Authorized Official Name | STEWART NELSON (CEO) |
| Authorized Official Telephone | 4345173183 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261Q00000X | Clinic/Center | 0101037012 | VA | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Halifax Urology Associates | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508110057 | Dominion Health Medical Associates | Dentist | 101 Aubreys Loop, South Boston, VA 24592-5056 | 2012-11-06 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | DOMINION HEALTH MEDICAL ASSOCIATES LTD. | 2204 Wilborn Ave, South Boston, Virginia 24592 |
| 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 |
| 1316267750 | Gareth Murchison Titus | Specialist | 2232 Wilborn Ave, Suite A, South Boston, VA 24592-1662 | 2010-06-08 |
| 1598099376 | Janardhan Srinivasan | Internal Medicine | 2232 Wilborn Ave, South Boston, VA 24592-1662 | 2009-09-25 |
| 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 | 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 |
| 1760740625 | Dominion Health Medical Assoc | Clinic/Center | 2206 Wilborn Ave, South Boston, VA 24592 | 2012-04-30 |
| 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.