Healthcare Provider Details

I. General information

NPI: 1821194549
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16320 CHURCH STREET
AMELIA VA
23002-4817
US

IV. Provider business mailing address

PO BOX 392
AMELIA COURT HOUSE VA
23002-0392
US

V. Phone/Fax

Practice location:
  • Phone: 804-561-2711
  • Fax: 804-561-2712
Mailing address:
  • Phone: 804-561-2711
  • Fax: 804-561-2712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ALEXANDER P SAMUEL
Title or Position: DISTRICT HEALTH DIRECTOR
Credential: M.D.
Phone: 434-392-3984