Healthcare Provider Details

I. General information

NPI: 1558451575
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1480 N MAIN ST
MADISON VA
22727-3093
US

IV. Provider business mailing address

640 LAUREL ST
CULPEPER VA
22701-3910
US

V. Phone/Fax

Practice location:
  • Phone: 540-948-5481
  • Fax: 540-948-3841
Mailing address:
  • Phone: 540-948-5481
  • Fax: 540-347-6373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANA MCCLELLAND
Title or Position: ADMINISTRATOR
Credential:
Phone: 540-316-6303