Provider Demographics
NPI:1932160355
Name:VIRGINIA DEPARTMENT OF HEALTH
Entity Type:Organization
Organization Name:VIRGINIA DEPARTMENT OF HEALTH
Other - Org Name:TAZEWELL COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS
Authorized Official - Prefix:
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-988-5585
Mailing Address - Street 1:PO BOX 350
Mailing Address - Street 2:
Mailing Address - City:TAZEWELL
Mailing Address - State:VA
Mailing Address - Zip Code:24651-9700
Mailing Address - Country:US
Mailing Address - Phone:276-988-5585
Mailing Address - Fax:276-988-5471
Practice Address - Street 1:253 CHAMBER DR
Practice Address - Street 2:
Practice Address - City:TAZEWELL
Practice Address - State:VA
Practice Address - Zip Code:24651-9700
Practice Address - Country:US
Practice Address - Phone:276-988-5585
Practice Address - Fax:276-988-5471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA=========OtherFIN
VAC08814Medicare PIN
VA=========OtherFIN