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General NPI Number Information
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NPI Number | 1912003617
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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 | 09/16/2006
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Last Update Date | 09/28/2010
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Provider Practice Location Address
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Address Line | 111 SOUTH ST GROUND FLOOR
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City | FARMVILLE
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State | VA
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Zip | 23901-1328
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Country | US
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Telephone | 434-392-8187
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Fax | 434-392-1088
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Provider Business Mailing Address
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Address Line | 111 SOUTH ST GROUND FLOOR
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City | FARMVILLE
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State | VA
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Zip | 23901-1328
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Country | US
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Telephone | 434-392-8187
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Fax | 434-392-1088
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Authorized Official
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Title or Position | DISTRICT HEALTH DIRECTOR
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Name | DR. ALEXANDER P SAMUEL
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Credential | M.D.
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Telephone | 434-392-3984
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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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