Provider Demographics
NPI:1992846570
Name:HALIFAX REGIONAL MEDICAL CENTER INC
Entity Type:Organization
Organization Name:HALIFAX REGIONAL MEDICAL CENTER INC
Other - Org Name:HALIFAX MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:EMERY
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-535-8005
Mailing Address - Street 1:250 SMITH CHURCH RD
Mailing Address - Street 2:P.O. BOX 1089
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-4914
Mailing Address - Country:US
Mailing Address - Phone:252-535-8005
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:252-535-8005
Practice Address - Fax:252-535-8466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0230207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07637OtherBLUE CROSS BS ER PHYS.
MD58593301OtherBCBS OF MARYLAND
NY007265OtherEMPIRE BCBS OF NEW YORK
NC6907637Medicaid
NC8907669Medicaid
NC00242OtherBLUE CROSS BLUE SHIELD NC
NC3400151Medicaid
NC07669OtherBCBS EKG
SC00380OtherBCBS OF SOUTH CAROLINA
VA216203OtherANTHEM BC BS OF VIRGINIA
NC3400151Medicaid
SC00380OtherBCBS OF SOUTH CAROLINA
NC07669OtherBCBS EKG
NC00242OtherBLUE CROSS BLUE SHIELD NC