Provider Demographics
NPI:1710936729
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:APPOMATTOX COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CENTRAL VA. HEALTH DISTRIC
Authorized Official - Prefix:
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:GATELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-6777
Mailing Address - Street 1:PO BOX 355
Mailing Address - Street 2:475 COURT STREET
Mailing Address - City:APPOMATTOX
Mailing Address - State:VA
Mailing Address - Zip Code:24522-0355
Mailing Address - Country:US
Mailing Address - Phone:434-352-2313
Mailing Address - Fax:
Practice Address - Street 1:475 COURT STREET
Practice Address - Street 2:
Practice Address - City:APPOMATTOX
Practice Address - State:VA
Practice Address - Zip Code:24522
Practice Address - Country:US
Practice Address - Phone:434-352-2313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA21236OtherOPTIMA
VA004975260Medicaid
VA266451OtherANTHEM
VA00994OtherSOUTHERN HEALTH CARENET
VA61553OtherCARENET
VA600888853Medicare PIN
VAC08759Medicare PIN