Provider Demographics
NPI:1316945421
Name:HALIFAX MEDICAL EQUIPMENT, INC
Entity type:Organization
Organization Name:HALIFAX MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:434-575-1117
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-0789
Mailing Address - Country:US
Mailing Address - Phone:434-575-1117
Mailing Address - Fax:434-575-1366
Practice Address - Street 1:4119 HALIFAX RD
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-4833
Practice Address - Country:US
Practice Address - Phone:434-575-1117
Practice Address - Fax:434-575-1366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0206009176332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009111239Medicaid
VA245614OtherANTHEM BCBS
VA009111239Medicaid