Healthcare Provider Details

I. General information

NPI: 1144339144
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 HALIFAX ST
PETERSBURG VA
23803-6335
US

IV. Provider business mailing address

301 HALIFAX ST
PETERSBURG VA
23803-6335
US

V. Phone/Fax

Practice location:
  • Phone: 804-863-1652
  • Fax: 804-862-6126
Mailing address:
  • Phone: 804-863-1652
  • Fax: 804-862-6126

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: DR. KATHRYN A RANKIN
Title or Position: DISTRICT HEALTH DIRECTOR
Credential: MD
Phone: 804-863-1652