Provider Demographics
NPI:1558390302
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:SUSSEX COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
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:MD
Authorized Official - Phone:804-863-1652
Mailing Address - Street 1:20103 PRINCETON RD
Mailing Address - Street 2:P.O. BOX 13435
Mailing Address - City:SUSSEX
Mailing Address - State:VA
Mailing Address - Zip Code:23884
Mailing Address - Country:US
Mailing Address - Phone:434-246-8611
Mailing Address - Fax:434-246-8610
Practice Address - Street 1:20103 PRINCETON RD
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:VA
Practice Address - Zip Code:23884
Practice Address - Country:US
Practice Address - Phone:434-246-8611
Practice Address - Fax:434-246-8610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
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
VA42517OtherSOUTHERN HEALTH
VA41198OtherOPTIMA/SENTARA
VA004975995Medicaid
VA266465OtherANTHEM
VA85732OtherVIRGINIA PREMIER
VA42577OtherCARENET
VA004975995Medicaid