Provider Demographics
NPI:1215978010
Name:HALIFAX HEALTHCARE SYSTEMS INC
Entity type:Organization
Organization Name:HALIFAX HEALTHCARE SYSTEMS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VPPBFS
Authorized Official - Prefix:MR
Authorized Official - First Name:ARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-226-4590
Mailing Address - Street 1:740 DUNLAWTON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-4901
Mailing Address - Country:US
Mailing Address - Phone:386-947-4680
Mailing Address - Fax:
Practice Address - Street 1:740 DUNLAWTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-4901
Practice Address - Country:US
Practice Address - Phone:386-947-4680
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherGROUP TAX ID NUMBER
=========OtherGROUP TAX ID NUMBER