Commonwealth of Virginia State Board of Health
Organization Active NPI Health Service Clinic/Center · Hampton, VA
NPI 1144298142 · NPPES record last updated Sep 19, 2008
Key facts
- NPI
- 1144298142
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Health Service Clinic/Center 261QH0100X
- Legal business name
- COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
- Practice address
- 3130 Victoria Blvd
Hampton, VA 23661-1544 - Phone
- (757) 727-1172
- Fax
- (757) 727-1185
- NPI assigned
- Mar 8, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Authorized official
- Name
- Dr. Samuel W Berg, M.D., M.P.H.
- Title
- District Director
- Phone
- (757) 727-1172
Other NPIs on the same Medicare enrollment 45
Corporate family (same tax ID) 24
Practitioners 2
-
Natasha Dwamena, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040206000622 | VA | Part B Supplier - Clinic/Group Practice | 0547174369 |
Receives reassigned benefits from 30 practitioners 45 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Independence, VA; Prince George, VA; Jonesville, VA; Lawrenceville, VA; Lebanon, VA; Louisa, VA; Lynchburg, VA; Marion, VA… |
National Provider Directory
- Tax ID family
- Commonwealth of VA State
- Part of
- Commonwealth of VA State
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Health Service Clinic/Center | 261QH0100X | Yes |
Addresses
Primary practice location
3130 Victoria Blvd
Hampton, VA 23661-1544
Mailing address
3130 Victoria Blvd
Hampton, VA 23661-1544
Phone (757) 727-1172
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004975014 | Medicaid | VA | |
| 0036501 | Medicaid | VA | |
| 47211 | Other | VA | SENTARA HEALTH PROVIDER # |
| 089265 | Other | VA | ANTHEM PROVIDER NUMBER |
| 84962 | Other | VA | VIRGINIA PREMIER PROVID # |
Other names
- Hampton Health Department
Other providers in Hampton, VA
- Collaborative Health
- Lajuana M Collins
- Marisa Collins
- Jason Todd Combs
- Comfort Haven Community LLC
- Community Home Health LLC
- Commute 2Gether Transportation LLC
- Compassion House LLC
- Compassionate & Care Transporation, LLC
- Compassionate Community Complex
All providers in Hampton, VA · Health Service Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.