Provider Demographics
NPI:1710931365
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:STAUNTON AUGUSTA HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE SERVICE SUPERVISOR SENIOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HABEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-332-7830
Mailing Address - Street 1:1414 N AUGUSTA ST
Mailing Address - Street 2:P.O. BOX 2126
Mailing Address - City:STAUNTON
Mailing Address - State:VA
Mailing Address - Zip Code:24401-2401
Mailing Address - Country:US
Mailing Address - Phone:540-332-7830
Mailing Address - Fax:540-885-0149
Practice Address - Street 1:1414 N AUGUSTA ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2401
Practice Address - Country:US
Practice Address - Phone:540-332-7830
Practice Address - Fax:540-885-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004976517Medicaid
VA008450935Medicaid
VA004975600Medicaid
VA004976193Medicaid
VA004976525Medicaid
VA008450706Medicaid
VA004976070Medicaid
VA008450528Medicaid
VA008450757Medicaid
VA004975294Medicaid
VA004976533Medicaid
VA004976533Medicaid
VA004976517Medicaid
VA004975294Medicaid
VA008450706Medicaid
VA004975600Medicaid
VA600-936-264Medicare ID - Type UnspecifiedWAYNESBORO
VA008450935Medicaid