Provider Demographics
NPI:1841241874
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:PAGE COUNTY HEALTH DEPT.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:D
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:540-722-3470
Mailing Address - Street 1:10 BAKER STREET
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-4828
Mailing Address - Country:US
Mailing Address - Phone:540-722-3470
Mailing Address - Fax:540-722-3476
Practice Address - Street 1:75 COURT LN
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1055
Practice Address - Country:US
Practice Address - Phone:540-743-6528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-15
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975812Medicaid
VA207998OtherANTHEM/HEALTHKEEPERS
VA207998OtherANTHEM/HEALTHKEEPERS
VA600000014Medicare ID - Type UnspecifiedPAGE CO HEALTH