Commonwealth of Virginia State Board of Health
Organization Active NPI Public Health or Welfare Agency · Powhatan, VA
NPI 1366462137 · NPPES record last updated May 29, 2012
Key facts
- NPI
- 1366462137
- 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
- 3908 Old Buckingham Rd
Suite 1
Powhatan, VA 23139-5753 - Phone
- (804) 598-5680
- Fax
- (804) 598-5688
- NPI assigned
- Jul 21, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Paulette A Moore
- Title
- Business Manager
- Phone
- (804) 748-1630
Corporate family (same tax ID) 24
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031117000414 | VA | Part B Supplier - Public Health/Welfare Agency | 0547174369 |
Receives reassigned benefits from 6 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Commonwealth of VA State
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
3908 Old Buckingham Rd
Suite 1
Powhatan, VA 23139-5753
Mailing address
3908 Old Buckingham Rd
Suite 1
Powhatan, VA 23139-5753
Phone (804) 598-5680
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 41199 | Other | OPTIMA FAMILY CARE | |
| 004975847 | Medicaid | VA | |
| 12499 | Other | CARENET/SOUTHERN HEALTH | |
| 266459 | Other | VA | ANTHEM BLUE CROSS BSHIELD |
| 4975847 | Other | VIRGINIA PREMIER HEALTH |
Other names
- Powhatan County Health Department
Other providers in Powhatan, VA
- Kristen Carter
- Tonya Renee Carter
- Tyler Adam Cepeda-Laporte
- Nicole Ashley Cole
- Jean Elaine Coleman
- Barbara C Connell
- Christopher Lee Corker
- Alicia N. Cress
- Felix Cruz
- Daniel Paul Curran
All providers in Powhatan, VA · Public Health or Welfare Agency in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 29, 2012. 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.