Provider Demographics
NPI:1427018977
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:BEDFORD COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH, CPE
Authorized Official - Phone:540-586-7952
Mailing Address - Street 1:600 BEDFORD AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-1966
Mailing Address - Country:US
Mailing Address - Phone:540-586-7952
Mailing Address - Fax:540-586-7950
Practice Address - Street 1:600 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-1966
Practice Address - Country:US
Practice Address - Phone:540-586-7952
Practice Address - Fax:540-586-7950
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975308Medicaid
VA004975308OtherVIRGINIA PREMIER
VA61555OtherCARENET
VA052026OtherANTHEM
VA96856OtherOPTIMA
VA052026OtherANTHEM
VA61555OtherCARENET
VA600001818Medicare PIN