Provider Demographics
NPI:1851332746
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:CAROLINE COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROSSHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MHP
Authorized Official - Phone:540-899-4797
Mailing Address - Street 1:608 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22401-5719
Mailing Address - Country:US
Mailing Address - Phone:540-899-4797
Mailing Address - Fax:540-899-4599
Practice Address - Street 1:17202 RICHMOND TURNPIKE
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:VA
Practice Address - Zip Code:22514-2211
Practice Address - Country:US
Practice Address - Phone:804-633-5465
Practice Address - Fax:804-633-6349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
VA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266519OtherANTHEM-HK
VA004975367OtherVIRGINIA PREMIER
VA000030333OtherMEDICAID-SLH
VA26965OtherOPTIMA
VA418738OtherSOUTHERN HEALTH
VA004975367Medicaid
VA45731OtherCARENET
VA600000081Medicare ID - Type UnspecifiedMEDICARE