Provider Demographics
NPI:1649385907
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:RADFORD CITY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-831-5774
Mailing Address - Street 1:200 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141
Mailing Address - Country:US
Mailing Address - Phone:540-831-5774
Mailing Address - Fax:540-831-6109
Practice Address - Street 1:200 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141
Practice Address - Country:US
Practice Address - Phone:540-831-5774
Practice Address - Fax:540-831-6109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004976223Medicaid
VA412940OtherSOUTHERNHEALTH
VA004976223Medicaid
VA435417OtherANTHEM/BC/HEALTHKEEPERS
VA435417OtherANTHEM/BC/HEALTHKEEPERS
VA600000021Medicare PIN