Healthcare Provider Details

I. General information

NPI: 1447285622
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 JACKSON STREET
BLAND VA
24315
US

IV. Provider business mailing address

PO BOX 176 209 JACKSON STREET
BLAND VA
24315
US

V. Phone/Fax

Practice location:
  • Phone: 276-688-3642
  • Fax: 276-688-4514
Mailing address:
  • Phone:
  • Fax:

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: ANNA H STEVENS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 276-781-7450