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General NPI Number Information
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NPI Number | 1710949771
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
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Dates
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Enumeration Date | 04/05/2006
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Last Update Date | 08/29/2008
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Provider Practice Location Address
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Address Line | 116 KABLER LANE
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City | RUSTBURG
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State | VA
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Zip | 24588
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Country | US
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Telephone | 434-332-9550
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Fax | 434-332-5512
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Provider Business Mailing Address
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Address Line | PO BOX 160
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City | RUSTBURG
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State | VA
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Zip | 24588-0160
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Country | US
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Telephone | 434-332-9550
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Fax | 434-332-5512
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Authorized Official
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Title or Position | DIRECTOR CENTRAL VA HEALTH DISTRIC
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Name | DR. KERRY W GATELEY
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Credential | MD, MPH, CPE
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Telephone | 434-947-6777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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