NPIMap

Organization Active NPI

Commonwealth of Virginia State Board of Health

Doing business as Suffolk Health Department

  • State or Local Public Health Clinic/Center
  • Suffolk, VA
National Provider Identifier
1487629374
Registry record updated Feb 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
State or Local Public Health Clinic/CenterTaxonomy code 261QP0905X
Legal business name
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Doing business as
Suffolk Health Department
Practice address
135 Hall Avenue
Suite a
Suffolk, VA 23434-4657
Phone
(757) 514-4700
Fax
(757) 514-4873
NPI assigned
Feb 22, 2006
Last updated
Feb 9, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angela Yvette Tillery
Title
Business Manager
Phone
(757) 514-4765

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
State or Local Public Health Clinic/Center 261QP0905X NU Primary

Addresses

Primary practice location

135 Hall Avenue
Suite a
Suffolk, VA 23434-4657

Mailing address

P.O. Box 1587
135 Hall Avenue, Suite a
Suffolk, VA 23434-4657
Phone (757) 514-4700

Other identifiers 4

IdentifierTypeStateIssuer
008770271MedicaidVA
4972279MedicaidVA
4976240MedicaidVA
008700664MedicaidVA

Other names 1

  • Suffolk Health Department Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100216000415 VA Part B Supplier - Mass Immunization (Roster Biller Only) 0547174369 Practice locations: Suffolk, VA

Other NPIs with the same Medicare PAC ID 9

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

National Provider Directory

National Provider Directory
Tax ID family
Dickenson Co Health Dep163 organizations share this tax ID, including this one
Part of
Dickenson Co Health Dep

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

135 Hall Ave
Ste A
Suffolk, VA 23434
Phone (757) 514-4700

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1265673600000",
    "number": "1487629374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1587",
            "address_2": "135 HALL AVENUE, SUITE A",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344657",
            "telephone_number": "757-514-4700",
            "fax_number": "757-514-4873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 HALL AVENUE",
            "address_2": "SUITE A",
            "city": "SUFFOLK",
            "state": "VA",
            "postal_code": "234344657",
            "telephone_number": "757-514-4700",
            "fax_number": "757-514-4873"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH",
        "enumeration_date": "2006-02-22",
        "last_updated": "2010-02-09",
        "status": "A",
        "authorized_official_last_name": "TILLERY",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "YVETTE",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "757-514-4765"
    },
    "taxonomies": [
        {
            "code": "261QP0905X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Public Health, State or Local",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008770271",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4972279",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4976240",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008700664",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Suffolk Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Suffolk, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.