Provider Demographics
NPI:1053355859
Name:COMMONWEATLH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEATLH 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 1:15068 LEE HIGHWAY
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24202
Mailing Address - Country:US
Mailing Address - Phone:276-676-5604
Mailing Address - Fax:276-645-1994
Practice Address - Street 1:15068 LEE HIGHWAY
Practice Address - Street 2:SUITE 1000
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24202
Practice Address - Country:US
Practice Address - Phone:276-676-5604
Practice Address - Fax:276-645-1994
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004976011Medicaid
VA00V648C68Medicare PIN
VA005631C68Medicare PIN
VA00V647C68Medicare PIN
VAC08868Medicare PIN
VA600000055Medicare PIN
VA600936722Medicare PIN
VA00V646C68Medicare PIN