Healthcare Provider Details

I. General information

NPI: 1386739456
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23191 FRONT STREET
ACCOMAC VA
23301
US

IV. Provider business mailing address

PO BOX 177
ACCOMAC VA
23301-0177
US

V. Phone/Fax

Practice location:
  • Phone: 757-787-5880
  • Fax: 757-787-5841
Mailing address:
  • Phone: 757-787-5880
  • Fax: 757-787-5841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateVA

VIII. Authorized Official

Name: MR. SCOTT CHANDLER
Title or Position: ADMINISTRATIVE MANAGER
Credential:
Phone: 757-787-5880