Provider Demographics
NPI:1659444586
Name:HALIFAX EAR NOSE AND THROAT CENTER PC
Entity Type:Organization
Organization Name:HALIFAX EAR NOSE AND THROAT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:B
Authorized Official - Last Name:RIBNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-572-4394
Mailing Address - Street 1:2100 WILBORN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-1628
Mailing Address - Country:US
Mailing Address - Phone:434-572-4394
Mailing Address - Fax:434-572-4978
Practice Address - Street 1:2100 WILBORN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-1628
Practice Address - Country:US
Practice Address - Phone:434-572-4394
Practice Address - Fax:434-572-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V625H51Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL NUMBE
VAC08851Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
VAA47514Medicare UPIN