| Halifax Endocrinology And Osteoporosis Center Pc | |
|
2232 Wilborn Ave Suite B South Boston VA 24592-1662 | |
| (434) 575-5844 | |
| (434) 575-0862 |
| Full Name | Halifax Endocrinology And Osteoporosis Center Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2232 Wilborn Ave, South Boston, Virginia |
| Authorized Official Name and Position | Tessie Otero-truitt (OWNER/PRESIDENT) |
| Authorized Official Contact | 4345755844 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Halifax Endocrinology And Osteoporosis Center Pc 2232 Wilborn Ave Ste B South Boston VA 24592-1662 Ph: (434) 575-5844 | Halifax Endocrinology And Osteoporosis Center Pc 2232 Wilborn Ave Suite B South Boston VA 24592-1662 Ph: (434) 575-5844 |
| NPI Number | 1801900113 |
|---|---|
| Provider Enumeration Date | 08/17/2006 |
| Last Update Date | 04/30/2015 |
| Medicare PECOS PAC ID | 0648347807 |
|---|---|
| Medicare Enrollment ID | O20080930000448 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801900113 | NPI | - | NPPES |
| 006082807 | Medicaid | VA | |
| 44141 | Other | VA | OPTIMA |
| 281110 | Other | VA | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 0101052342 (Virginia) | Primary |
| Provider Name | Tessie Otero Truitt |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1700881885 PECOS PAC ID: 6305943192 Enrollment ID: I20070511000417 |
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