1. Home
  2. Directory
  3. Virginia
  4. South Boston
  5. Legal Medicine
  6. NPI Profile

SENTARA HALIFAX FAMILY MEDICINE
NPI 1407051873
Legal Medicine in South Boston, VA

Active since June 18, 2007CLIA 49D1090106 · Waiver
101 AUBREY'S LOOP RD, SOUTH BOSTON, VA 24592(434) 517-3788(434) 517-3887 Get Directions Write a Review

NPPES record last updated: February 10, 2015. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Sentara Halifax Family Medicine NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SENTARA HALIFAX FAMILY MEDICINE (NPI 1407051873) is a healthcare organization registered as a legal medicine in South Boston, Virginia and active in the NPI registry since June 2007. The organization holds a CLIA Waiver certificate valid through October 1, 2026 and lists Cecil Hazelwood, Manager (sdhg), as its authorized official.

NPPES Registry Identity

NPI1407051873
Entity TypeOrganization
Primary Taxonomy173000000X
Legal Business NameDOMINION HEALTH MEDICAL ASSOC
Location Address101 AUBREY'S LOOP RDSouth Boston, VA 24592
Mailing AddressP.o. Box 860South Boston, VA 24592 · (434) 517-3513 · Fax (434) 517-3887
Phone(434) 517-3788
Fax(434) 517-3887
Organization SubpartNo
Authorized OfficialCecil HazelwoodManager (sdhg) · (434) 517-3515
Enumeration DateJune 18, 2007
Last NPPES UpdateFebruary 10, 2015
✔ NPI 1407051873 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyLegal MedicineOther Service Providers
Taxonomy Code173000000X
License✔ Licensed in VA · 0101054916
Definition

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.

101 AUBREY'S LOOP RD, South Boston, VA 24592
Open in Google Maps ↗

Other Names 1

Doing Business AsSentara Halifax Family Medicine

Other Identifiers 1

Medicare UPING04732VA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 5

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D1090106

Sentara Halifax Family Medicine · South Boston, VA
Active · expires Oct 1, 2026
CLIA Number49D1090106
Laboratory TypePhysician Office
Certificate Effective DateOctober 2, 2024
Certificate Expiration DateOctober 1, 2026
Laboratory DirectorPablo C. Souza
Laboratory Phone(434) 517-3216
Laboratory LocationSentara Halifax Family Medicine101 Aubreys Loop, South Boston, VA 24592
CLIA data matches this NPI record on: Name
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2172019

Sentara Halifax Home Care Services Sentara Halifax Hospice · South Boston, VA
Active · expires Sep 11, 2027
CLIA Number49D2172019
Laboratory TypeHome Health Agency
Certificate Effective DateSeptember 12, 2025
Certificate Expiration DateSeptember 11, 2027
Laboratory DirectorNicole Hayden
Laboratory Phone(434) 517-3701
Laboratory LocationSentara Halifax Home Care Services Sentara Halifax Hospice2200 Wilborn Ave, South Boston, VA 24592
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Accreditation 49D0233332

Sentara Halifax Regional Hospital Lab · South Boston, VA
Active · expires Feb 27, 2027
CLIA Number49D0233332
Laboratory TypeHospital
Certificate Effective DateFebruary 28, 2025
Certificate Expiration DateFebruary 27, 2027
Laboratory DirectorDr. Pablo C. Souza
Laboratory Phone(804) 575-3231
Laboratory LocationSentara Halifax Regional Hospital Lab2204 Wilborn Ave Attn Ed Agricola, South Boston, VA 24592
This is a certificate that is issued to a laboratory on the basis of the laboratory's accreditation by an accreditation organization approved by CMS.

Certificate of Waiver 49D2087553

Sentara Halifax Pediatrics · South Boston, VA
Active · expires Nov 27, 2026
CLIA Number49D2087553
Laboratory TypePhysician Office
Certificate Effective DateNovember 28, 2024
Certificate Expiration DateNovember 27, 2026
Laboratory DirectorPablo C. Souza
Laboratory Phone(434) 517-8022
Laboratory LocationSentara Halifax Pediatrics2100 Wilborn Avenue, South Boston, VA 24592
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 49D2176341

Sentara Halifax Regional Hospital-Behavioral Health Department · South Boston, VA
Expired · Dec 11, 2025
CLIA Number49D2176341
Laboratory TypeAncillary Testing Site In Health Care Center
Certificate Effective DateDecember 12, 2023
Certificate Expiration DateDecember 11, 2025
Laboratory DirectorGregory Weiss
Laboratory Phone(434) 517-3885
Laboratory LocationSentara Halifax Regional Hospital-Behavioral Health Department504 Wilborn Avenue, South Boston, VA 24592
This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions

What is DOMINION HEALTH MEDICAL ASSOC's NPI number?

The NPI number assigned to this healthcare provider is 1407051873, enumerated as an "organization" on June 18, 2007.

Where is the provider located?

The provider is located at 101 AUBREY'S LOOP RD SOUTH BOSTON, VA 24592 and the phone number is (434) 517-3788.

What is the provider's specialty?

Legal Medicine with taxonomy code 173000000X.

What insurance does DOMINION HEALTH MEDICAL ASSOC accept?

The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to verify.