Provider Demographics
NPI:1932218153
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity Type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:PATRICK COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DISTRICT BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-638-2311
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:VA
Mailing Address - Zip Code:24171-0428
Mailing Address - Country:US
Mailing Address - Phone:276-694-3188
Mailing Address - Fax:276-694-6784
Practice Address - Street 1:106 RUCKER ST
Practice Address - Street 2:SUITE123
Practice Address - City:STUART
Practice Address - State:VA
Practice Address - Zip Code:24171-1619
Practice Address - Country:US
Practice Address - Phone:276-694-3188
Practice Address - Fax:276-694-6784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975821Medicaid
VAC08715Medicare PIN