Provider Demographics
NPI:1396858197
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:LEXINGTON ROCKBRIDGE HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SERVICE SUPERVISOR SENIOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-332-7830
Mailing Address - Street 1:300 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-1937
Mailing Address - Country:US
Mailing Address - Phone:540-463-3185
Mailing Address - Fax:540-463-6677
Practice Address - Street 1:300 WHITE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-1937
Practice Address - Country:US
Practice Address - Phone:540-463-3185
Practice Address - Fax:540-463-6677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA008450528Medicaid
VA004976525Medicaid
VA004976525Medicaid