Provider Demographics
NPI:1477596641
Name:HALIFAX HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:HALIFAX HEALTHCARE SYSTEMS INC
Other - Org Name:HHCSI KEECH STREET CLINIC
Other - Org Type:Doing Business As
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:386-254-4000
Mailing Address - Street 1:431 KEECH STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114
Mailing Address - Country:US
Mailing Address - Phone:386-947-3553
Mailing Address - Fax:
Practice Address - Street 1:431 KEECH STREET
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114
Practice Address - Country:US
Practice Address - Phone:386-947-3553
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherGROUP TAX ID NUMBER
FLK0373OMedicare Oscar/Certification