=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558451575
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/13/2006
-----------------------------------------------------
Last Update Date | 03/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1480 N MAIN ST
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22727-3093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-948-5481
-----------------------------------------------------
Fax | 540-948-3841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 640 LAUREL ST
-----------------------------------------------------
City | CULPEPER
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22701-3910
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 540-948-5481
-----------------------------------------------------
Fax | 540-347-6373
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MRS. DANA MCCLELLAND
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 540-316-6303
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP0905X
-----------------------------------------------------
Taxonomy Name | State or Local Public Health Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------