Provider Demographics
NPI:1831123785
Name:HALIFAX HEALTHCARE SYSTEMS INC
Entity Type:Organization
Organization Name:HALIFAX HEALTHCARE SYSTEMS INC
Other - Org Name:HHCSI HALIFAX DUNN HEALTH 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:386-226-4590
Mailing Address - Street 1:1425 DUNN AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1437
Mailing Address - Country:US
Mailing Address - Phone:386-239-6198
Mailing Address - Fax:
Practice Address - Street 1:1425 DUNN AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-1437
Practice Address - Country:US
Practice Address - Phone:386-239-6198
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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