Healthcare Provider Details

I. General information

NPI: 1841241874
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: 11/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 COURT LN
LURAY VA
22835-1055
US

IV. Provider business mailing address

10 BAKER STREET
WINCHESTER VA
22601-4828
US

V. Phone/Fax

Practice location:
  • Phone: 540-743-6528
  • Fax:
Mailing address:
  • Phone: 540-722-3470
  • Fax: 540-722-3476

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. DAVID D CRABTREE
Title or Position: DISTRICT ADMINISTRATOR
Credential: M.S.
Phone: 540-722-3470