DOMINION HEALTH MEDICAL ASSOC NPI 1407051873

NPI Information

  • NPI: 1407051873
  • Provider Name: DOMINION HEALTH MEDICAL ASSOC
  • Classification: Legal Medicine - 173000000X
  • Entity Type: Organization
  • Doing Business As: SENTARA HALIFAX FAMILY MEDICINE
  • CLIA Number: 49D1090106
  • Address: 101 AUBREY'S LOOP RD
    SOUTH BOSTON, VA
    ZIP 24592
  • Phone: (434) 517-3788

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NPI Details

DOMINION HEALTH MEDICAL ASSOC is a legal medicine in South Boston, VA. The provider is the specialty areas of medicine concerned with matters of, and relations with, substantive law and legal institutions; such as the conduct of medical examinations at crime scenes, performance of autopsies, giving of expert medical testimony in judicial proceedings, medical treatment of inmates of penal institutions, the practice of trauma medicine in law enforcement settings, and other clinical practice and medical science applications in the fields of law, law enforcement, and corrections. DOMINION HEALTH MEDICAL ASSOC NPI is 1407051873. The provider is registered as an organization entity type and is a single specialty group.
The provider Is Doing Business As Sentara Halifax Family Medicine.

The provider's business location address is:

101 AUBREY'S LOOP RD
SOUTH BOSTON, VA
ZIP 24592
Phone: (434) 517-3788
Fax: (434) 517-3887

The provider's authorized official is Cecil Hazelwood .
The authorized official title is Manager (sdhg) and has the following contact phone number (434) 517-3515.

The CLIA number assigned to this NPI record is 49D1090106 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/18/2007 and was last updated on 2/10/2015.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1173000000XLegal Medicine0101054916VIRGINIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1G04732MEDICARE UPINVIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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