Provider Demographics
NPI:1083665020
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:SHENANDOAH COUNTY HEALTH DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:540-722-3470
Mailing Address - Street 1:10 BAKER STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4828
Mailing Address - Country:US
Mailing Address - Phone:540-722-3470
Mailing Address - Fax:540-722-3476
Practice Address - Street 1:494 N MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WOODSTOCK
Practice Address - State:VA
Practice Address - Zip Code:22664-1872
Practice Address - Country:US
Practice Address - Phone:540-459-3733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA229554OtherANTHEM/HEALTHKEEPERS
VA004975936Medicaid
VA229554OtherANTHEM/HEALTHKEEPERS
VA004975936Medicaid