MEDICARE: COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251K00000X	Public Health or Welfare Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4975987	OTHER	VA	VIRGINIA PREMIER
3	41997	OTHER	VA	OPTIMA/SENTARA
4	45763	OTHER	VA	CARENET
5	42517	OTHER	VA	SOUTHERN HEALTH
6	266464	OTHER	VA	ANTHEM

General Provider Information

NPI Number	:	1518996768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Provider Business Mailing Address
First Line	:	PO BOX 213
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-0213
Country	:	US
Telephone Number	:	757-294-3185
Fax Number	:	757-294-3756

Provider Business Practice Location Address
First Line	:	474 COLONIAL TRAIL WEST
Second Line	:
City	:	SURRY
State	:	VA
Zip	:	23883-0213
Country	:	US
Telephone Number	:	757-294-3185
Fax Number	:	757-294-3756

Authorized Official
Title or Position	:	DISTRICT HEALTH DIRECTOR
Name	:	DR. KATHRYN A RANKIN
Credential	:
Telephone Number	:	804-863-1652

Provider Enumeration Date	:	07/01/2006
Last Update Date	:	09/12/2008

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Directions to “COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH ” Practice Location

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