Healthcare Provider Details

I. General information

NPI: 1710938576
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 MADISON ST
BOYDTON VA
23917
US

IV. Provider business mailing address

969 MADISON ST
BOYDTON VA
23917-3418
US

V. Phone/Fax

Practice location:
  • Phone: 434-738-6545
  • Fax: 434-738-6295
Mailing address:
  • Phone: 434-738-6545
  • Fax: 434-738-6295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number1010243863
License Number StateVA

VIII. Authorized Official

Name: DR. SCOTT J SPILLMANN
Title or Position: SOUTHSIDE HEALTH DISTRICT
Credential: MD, MPH
Phone: 434-738-6545