Basic Information
| Provider Information | |||||||||
| NPI: | 1295923282 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HALIFAX ANESTHESIOLOGY ASSOCIATES PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2232 WILBORN AVE | ||||||||
| Address2: | P O BOX 1115 | ||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245921662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345173539 | ||||||||
| FaxNumber: | 4345724549 | ||||||||
| Practice Location | |||||||||
| Address1: | 2204 WILBORN AVE | ||||||||
| Address2: | |||||||||
| City: | SOUTH BOSTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245921645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4345173139 | ||||||||
| FaxNumber: | 4345173060 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| AuthorizedOfficialLastName: | MARQUEZ | ||||||||
| AuthorizedOfficialFirstName: | HECTOR | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4345173139 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282E00000X | N | Hospitals | Long Term Care Hospital | 282E00000X | VA | N | Hospitals | Long Term Care Hospital | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.