Commonwealth of Virginia State Board of Health

Organization Active NPI Public Health or Welfare Agency · Portsmouth, VA

NPI 1295795078 · NPPES record last updated Mar 2, 2012

Key facts

NPI
1295795078
Entity type
Organization (NPI type 2)
Primary specialty
Public Health or Welfare Agency 251K00000X
Legal business name
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Practice address
1701 High Street
Suite 102
Portsmouth, VA 23704
Phone
(757) 393-8585
Fax
(757) 393-8027
NPI assigned
Mar 24, 2006
Organization subpart
No

Authorized official

Name
Dr. David Chang, M.D.
Title
Health Director
Phone
(757) 393-8582

Other NPIs with the same Medicare PAC ID 9

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031117000414 VA Part B Supplier - Public Health/Welfare Agency 0547174369 Receives reassigned benefits from 6 practitioners

National Provider Directory

Tax ID family
Commonwealth of VA State (163 organizations share this tax ID)

Locations

1701 High St
#102
Portsmouth, VA 23704
Phone (757) 393-8585

1701 High St
Portsmouth, VA 23704
Phone (757) 393-8585

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X VA Yes

Addresses

Primary practice location

1701 High Street
Suite 102
Portsmouth, VA 23704

Mailing address

1701 High Street
Suite 102
Portsmouth, VA 23704
Phone (757) 393-8585

Other identifiers

IdentifierTypeStateIssuer
49-7512-0MedicaidVA

Other names

  • Portsmouth Health District Other name

Other providers in Portsmouth, VA

All providers in Portsmouth, VA · Public Health or Welfare Agency in Virginia

Sources for this page

Verify at the official NPI Registry.