Provider Demographics
NPI:1629029483
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:HALIFAX 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:434-738-6545
Mailing Address - Street 1:PO BOX 845
Mailing Address - Street 2:
Mailing Address - City:HALIFAX
Mailing Address - State:VA
Mailing Address - Zip Code:24558-0845
Mailing Address - Country:US
Mailing Address - Phone:434-738-6545
Mailing Address - Fax:434-738-6295
Practice Address - Street 1:1030 COWFORD ROAD
Practice Address - Street 2:
Practice Address - City:HALIFAX
Practice Address - State:VA
Practice Address - Zip Code:24558
Practice Address - Country:US
Practice Address - Phone:434-476-4863
Practice Address - Fax:434-476-4869
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-15
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1010243863251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975570Medicaid
VA4975570Medicaid
VA266537OtherANTHEM BCBS
VA005840686Medicaid
VA25574OtherOPTIMA
VA600953554Medicare PIN
VA4975570Medicaid
VA25574OtherOPTIMA
VAC10827Medicare PIN
VA600953554Medicare ID - Type Unspecified