Provider Demographics
NPI:1831106327
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:FLUVANNA COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:434-972-6219
Mailing Address - Street 1:PO BOX 136
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:VA
Mailing Address - Zip Code:22963-0136
Mailing Address - Country:US
Mailing Address - Phone:434-591-1960
Mailing Address - Fax:434-591-1961
Practice Address - Street 1:132 MAIN STREET
Practice Address - Street 2:COUNTY OFFICE BUILDING
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963
Practice Address - Country:US
Practice Address - Phone:434-591-1960
Practice Address - Fax:434-591-1961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266539OtherANTHEM
VA004975499Medicaid
VA42012OtherOPTIMA FAMILY CARE
VA42012OtherOPTIMA FAMILY CARE
VA600000048Medicare ID - Type UnspecifiedRAILROAD MEDICARE