Healthcare Provider Details

I. General information

NPI: 1073758181
Provider Name (Legal Business Name): COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2008
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 GOVERNOR ST FL 13
RICHMOND VA
23219-3623
US

IV. Provider business mailing address

109 GOVERNOR ST FL 13
RICHMOND VA
23219-3623
US

V. Phone/Fax

Practice location:
  • Phone: 804-864-7009
  • Fax: 804-864-7022
Mailing address:
  • Phone: 804-864-7009
  • Fax: 804-864-7022

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: KAREN E SHELTON
Title or Position: STATE HEALTH COMMISSIONER
Credential: MD
Phone: 804-864-7018