Provider Demographics
NPI:1790745321
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:LYNCHBURG HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR CENTRAL VA. HEALTH DISTICT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:GATELEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD,MPH, CPE
Authorized Official - Phone:434-477-5923
Mailing Address - Street 1:307 ALLEGHANY AVE
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2605
Mailing Address - Country:US
Mailing Address - Phone:434-477-5923
Mailing Address - Fax:434-947-2338
Practice Address - Street 1:1900 THOMSON DR
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1009
Practice Address - Country:US
Practice Address - Phone:434-947-6777
Practice Address - Fax:434-947-2338
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-27
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
VA004975111OtherVIRGINIA PREMIER
VA61176OtherCARENET
VA004975111Medicaid
VA003374OtherANTHEM
VA18765OtherOPTIMA
VAC08759Medicare PIN
VA004975111OtherVIRGINIA PREMIER
VA003374OtherANTHEM