Provider Demographics
NPI:1447285622
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-781-7450
Mailing Address - Street 1:PO BOX 176
Mailing Address - Street 2:209 JACKSON STREET
Mailing Address - City:BLAND
Mailing Address - State:VA
Mailing Address - Zip Code:24315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:BLAND
Practice Address - State:VA
Practice Address - Zip Code:24315
Practice Address - Country:US
Practice Address - Phone:276-688-3642
Practice Address - Fax:276-688-4514
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-12
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975316Medicaid
VA005631C68Medicare PIN
VAC08868Medicare PIN
VA004975316Medicaid
VA00V647C68Medicare PIN
VA600936266Medicare PIN
VAP00339618Medicare PIN