Provider Demographics
NPI:1336171164
Name:DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Entity Type:Organization
Organization Name:DIRECTOR OF FINANCE-COUNTY OF FAIRFAX VA
Other - Org Name:FAIRFAX COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY EXECUTIVE
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-324-3360
Mailing Address - Street 1:12000 GOVERNMENT CENTER PKWY
Mailing Address - Street 2:SUITE 552
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22035-0001
Mailing Address - Country:US
Mailing Address - Phone:703-324-3360
Mailing Address - Fax:703-324-4573
Practice Address - Street 1:10777 MAIN ST
Practice Address - Street 2:SUITE 202
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6903
Practice Address - Country:US
Practice Address - Phone:703-246-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF FAIRFAX, VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-06
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4970047Medicaid
W07698Medicare UPIN
VA4970047Medicaid
VA769047Medicare PIN