Provider Demographics
NPI:1346337979
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:PRINCE WILLIAM HEALTH DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:ANSHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD MPH
Authorized Official - Phone:703-792-7300
Mailing Address - Street 1:4001 PRINCE WILLIAM PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-7666
Mailing Address - Country:US
Mailing Address - Phone:703-792-7300
Mailing Address - Fax:703-792-7311
Practice Address - Street 1:4001 PRINCE WILLIAM PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-7666
Practice Address - Country:US
Practice Address - Phone:703-792-7300
Practice Address - Fax:703-792-7311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4975871Medicaid
VA4975871Medicaid