Provider Demographics
NPI:1659313179
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:GREENSVILLE/EMPORIA HEALTH DEPARTMENT
Other - Org Type:Other Name
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 1:140 URIAH BRANCH WAY
Mailing Address - Street 2:
Mailing Address - City:EMPORIA
Mailing Address - State:VA
Mailing Address - Zip Code:23847-6315
Mailing Address - Country:US
Mailing Address - Phone:434-348-4210
Mailing Address - Fax:434-348-4281
Practice Address - Street 1:140 URIAH BRANCH WAY
Practice Address - Street 2:
Practice Address - City:EMPORIA
Practice Address - State:VA
Practice Address - Zip Code:23847-6315
Practice Address - Country:US
Practice Address - Phone:434-348-4210
Practice Address - Fax:434-348-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA41193OtherOPTIMA/SENTARA
VA266461OtherANTHEM
VA42517OtherSOUTHERN HEALTH
VA45763OtherCARENET
VA004976118Medicaid
VA85736OtherVIRGINIA PREMIER
VA41193OtherOPTIMA/SENTARA