Provider Demographics
NPI:1619911427
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:GRAYSON COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-781-7450
Mailing Address - Street 1:PO BOX 650
Mailing Address - Street 2:186 W MAIN ST
Mailing Address - City:INDEPENDENCE
Mailing Address - State:VA
Mailing Address - Zip Code:24348
Mailing Address - Country:US
Mailing Address - Phone:276-773-2961
Mailing Address - Fax:276-773-2240
Practice Address - Street 1:186 WEST MAIN ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:VA
Practice Address - Zip Code:24348
Practice Address - Country:US
Practice Address - Phone:276-773-2961
Practice Address - Fax:276-773-2240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-15
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975545Medicaid
VAC08868Medicare PIN
VA004647C68Medicare PIN
VA00V646C68Medicare PIN
VA004975545Medicaid
VA00V648C68Medicare PIN
VA600936269Medicare PIN