Provider Demographics
NPI:1144351503
Name:HALIFAX MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:HALIFAX MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:HUME
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C,MPH
Authorized Official - Phone:252-445-2332
Mailing Address - Street 1:114 MARKET ST
Mailing Address - Street 2:PO BOX 339
Mailing Address - City:ENFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27823-0339
Mailing Address - Country:US
Mailing Address - Phone:252-445-2332
Mailing Address - Fax:252-445-2983
Practice Address - Street 1:114 MARKET ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:NC
Practice Address - Zip Code:27823-0339
Practice Address - Country:US
Practice Address - Phone:252-445-2332
Practice Address - Fax:252-445-2983
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALIFAX MEDICAL SERVICES PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC68222261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC343974A&CMedicaid
NC343974Medicare Oscar/Certification