Provider Demographics
NPI:1588647135
Name:COMMONWEALTH OF VA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VA STATE BOARD OF HEALTH
Other - Org Name:PITTSYLVANIA COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:J
Authorized Official - Last Name:SPILLMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:434-766-9800
Mailing Address - Street 1:PO BOX 1159
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:VA
Mailing Address - Zip Code:24531-1159
Mailing Address - Country:US
Mailing Address - Phone:434-432-7232
Mailing Address - Fax:434-432-7235
Practice Address - Street 1:200 H G MC GHEE DR
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531
Practice Address - Country:US
Practice Address - Phone:434-432-7232
Practice Address - Fax:434-432-7235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975839Medicaid
VA600000206OtherRAILROAD MEDICARE
VAC09395Medicare ID - Type Unspecified
VA004975839Medicaid