Provider Demographics
NPI:1184738692
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-381-7100
Mailing Address - Street 1:1 TAYLOR AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PEARISBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24134-2079
Mailing Address - Country:US
Mailing Address - Phone:540-921-2891
Mailing Address - Fax:540-921-1335
Practice Address - Street 1:1 TAYLOR AVE STE 4
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-2079
Practice Address - Country:US
Practice Address - Phone:540-921-2891
Practice Address - Fax:540-921-1335
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004976215Medicaid
VA10001610OtherSENTARA/OPTIMA
VA412937OtherSOUTHERNHEALTH
VA435415OtherANTHEM/BC/HEALTHKEEPERS
VA=========547OtherTRICARE
VA004976215Medicaid