Healthcare Provider Details

I. General information

NPI: 1184738692
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/14/2022
Certification Date: 09/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 TAYLOR AVE STE 4
PEARISBURG VA
24134-2079
US

IV. Provider business mailing address

1 TAYLOR AVE STE 4
PEARISBURG VA
24134-2079
US

V. Phone/Fax

Practice location:
  • Phone: 540-921-2891
  • Fax: 540-921-1335
Mailing address:
  • Phone: 540-921-2891
  • Fax: 540-921-1335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NOELLE BISSELL
Title or Position: HEALTH DIRECTOR
Credential: MD
Phone: 540-381-7100