Provider Demographics
NPI:1346273943
Name:HALIFAX REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HALIFAX REGIONAL MEDICAL CENTER INC
Other - Org Name:ECU HEALTH NORTH HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:BARNES
Authorized Official - Last Name:HARRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-535-8159
Mailing Address - Street 1:250 SMITH CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4914
Mailing Address - Country:US
Mailing Address - Phone:252-535-8011
Mailing Address - Fax:252-535-8466
Practice Address - Street 1:250 SMITH CHURCH RD
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-4914
Practice Address - Country:US
Practice Address - Phone:252-535-8011
Practice Address - Fax:252-535-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0230282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005630Medicaid
NC3400151Medicaid
MD58593301OtherBCBS OF MARYLAND
NC8907669Medicaid
NC00242OtherBLUE CROSS BLUE SHIELD NC
VA216203OtherANTHEM BCBS
NC251432OtherALLIANCE PPO
SC00380OtherBCBS SC
NC07669OtherBCBS PROF EKG INTERP
NY007265OtherEMPIRE BCBS NY
NC00242OtherBLUE CROSS BLUE SHIELD NC
NC251432OtherALLIANCE PPO
NCCI0514Medicare PIN
MD58593301OtherBCBS OF MARYLAND
NY007265OtherEMPIRE BCBS NY
NC8907669Medicaid