MEDICARE: HENRY COUNTY PUBLIC SERVICE AUTHORITY

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

General Provider Information

NPI Number	:	1679427140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY COUNTY PUBLIC SERVICE AUTHORITY

Provider Business Mailing Address
First Line	:	PO BOX 69
Second Line	:
City	:	COLLINSVILLE
State	:	VA
Zip	:	24078-0069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 KINGS MOUNTAIN RD
Second Line	:
City	:	MARTINSVILLE
State	:	VA
Zip	:	24112-6798
Country	:	US
Telephone Number	:	276-634-2500
Fax Number	:

Authorized Official
Title or Position	:	DATABASE ANALYST
Name	:	STACI WILLIAMS
Credential	:
Telephone Number	:	276-634-4626

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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Directions to “HENRY COUNTY PUBLIC SERVICE AUTHORITY ” Practice Location

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