Provider Demographics
NPI:1790813954
Name:HALIFAX X-RAY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:HALIFAX X-RAY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:
Authorized Official - Last Name:PIGGOTT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD,
Authorized Official - Phone:252-535-2121
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-0249
Mailing Address - Country:US
Mailing Address - Phone:252-535-2121
Mailing Address - Fax:252-535-1011
Practice Address - Street 1:19 E 11TH ST
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3840
Practice Address - Country:US
Practice Address - Phone:252-535-2121
Practice Address - Fax:252-535-1011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30569174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8901758Medicaid
NC8901758Medicaid