Provider Demographics
NPI:1518996768
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:SURRY COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:DISTRICT HEALTH DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-863-1652
Mailing Address - Street 1:PO BOX 213
Mailing Address - Street 2:
Mailing Address - City:SURRY
Mailing Address - State:VA
Mailing Address - Zip Code:23883-0213
Mailing Address - Country:US
Mailing Address - Phone:757-294-3185
Mailing Address - Fax:757-294-3756
Practice Address - Street 1:474 COLONIAL TRAIL WEST
Practice Address - Street 2:
Practice Address - City:SURRY
Practice Address - State:VA
Practice Address - Zip Code:23883-0213
Practice Address - Country:US
Practice Address - Phone:757-294-3185
Practice Address - Fax:757-294-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975987Medicaid
VA4975987OtherVIRGINIA PREMIER
VA41997OtherOPTIMA/SENTARA
VA45763OtherCARENET
VA42517OtherSOUTHERN HEALTH
VA266464OtherANTHEM
VA266464OtherANTHEM