Commonwealth of Virginia State Board of Health
Organization Active NPI Public Health or Welfare Agency · King William, VA
NPI 1528029675 · NPPES record last updated Mar 19, 2012
Key facts
- NPI
- 1528029675
- 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
- 172 Courthouse Lane
King William, VA 23086-0155 - Phone
- (804) 758-2381
- Fax
- (804) 758-4828
- NPI assigned
- Mar 29, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Sherry House
- Title
- Administrator
- Phone
- (804) 758-2381
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
172 Courthouse Lane
King William, VA 23086-0155
Mailing address
PO Box 155
King William, VA 23086-0155
Phone (804) 758-2381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528029675 | Other | VA | HUMANA GOLD CHOICE |
| 266548 | Other | VA | ANTHEM |
| 41163 | Other | VA | OPTIMA |
| 41163 | Other | VI | SENTARA |
| 99999999999 | Other | VA | DORAL |
| 004975651 | Medicaid | VA |
Other names
- KING WILLIAM COUNTY HEALTH DEPARTMENT
Other providers in King William, VA
- Hollie Bateman
- Michelle Bensen
- Bon Secours Memorial Regional Medical Center LLC
- Terica Tanelle Hodge Brown
- Cornerstone Community Services LLC
- Franklintransportation, LLC
- Leann Marie Hupalo
- King William County Public Schools
- Isabelle Kress
All providers in King William, 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 Mar 19, 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.