Healthcare Provider Details

I. General information

NPI: 1649385907
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 10/25/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN ST
RADFORD VA
24141
US

IV. Provider business mailing address

200 E MAIN ST
RADFORD VA
24141
US

V. Phone/Fax

Practice location:
  • Phone: 540-831-5774
  • Fax: 540-831-6109
Mailing address:
  • Phone: 540-831-5774
  • Fax: 540-831-6109

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: 540-831-5774