Provider Demographics
NPI:1235295338
Name:HALIFAX MEDICAL SERVICES PA
Entity Type:Organization
Organization Name:HALIFAX MEDICAL SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUME
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C, MPH
Authorized Official - Phone:252-977-0279
Mailing Address - Street 1:1444 JEFFREYS RD
Mailing Address - Street 2:#144
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-1820
Mailing Address - Country:US
Mailing Address - Phone:252-977-0279
Mailing Address - Fax:
Practice Address - Street 1:1444 JEFFREYS RD
Practice Address - Street 2:#144
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1820
Practice Address - Country:US
Practice Address - Phone:252-977-0279
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2338802Medicare PIN