Provider Demographics
NPI:1467542480
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:FAUQUIER COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCLELLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-316-6303
Mailing Address - Street 1:640 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-3910
Mailing Address - Country:US
Mailing Address - Phone:540-317-4116
Mailing Address - Fax:540-829-7345
Practice Address - Street 1:330 HOSPITAL DR
Practice Address - Street 2:SUITE 101
Practice Address - City:WARRENTON
Practice Address - State:VA
Practice Address - Zip Code:20186-3006
Practice Address - Country:US
Practice Address - Phone:540-347-6400
Practice Address - Fax:540-347-6405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4975472Medicaid
VA49D0714359OtherCLIA
VA49D0714359OtherCLIA
VA600000040Medicare ID - Type Unspecified