NPIMap

Organization Active NPI

Commonwealth of Virginia State Board of Health

Doing business as Franklin City Health Department

  • State or Local Public Health Clinic/Center
  • Franklin, VA
National Provider Identifier
1720053648
Registry record updated Jun 9, 2011
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
Franklin City Health Department
Practice address
200 Fairview Ave
Franklin, VA 23851-1216
Phone
(757) 562-6109
Fax
(757) 562-2630
NPI assigned
Feb 22, 2006
Last updated
Jun 9, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

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

200 Fairview Ave
Franklin, VA 23851-1216

Mailing address

200 Fairview Ave
PO Box 595
Franklin, VA 23851-0595
Phone (757) 562-6109

Other identifiers 3

IdentifierTypeStateIssuer
4976134MedicaidVA
008770336MedicaidVA
008700672MedicaidVA

Other names 1

  • Franklin City 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
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

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

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

200 Fairview Dr
Franklin, VA 23851
Phone (703) 555-1212

Practitioners & affiliated clinicians

Practitioners 1

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": "1307577600000",
    "number": "1720053648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 FAIRVIEW AVE",
            "address_2": "PO BOX 595",
            "city": "FRANKLIN",
            "state": "VA",
            "postal_code": "238510595",
            "telephone_number": "757-562-6109",
            "fax_number": "757-562-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 FAIRVIEW AVE",
            "city": "FRANKLIN",
            "state": "VA",
            "postal_code": "238511216",
            "telephone_number": "757-562-6109",
            "fax_number": "757-562-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-06-09",
        "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": "4976134",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008770336",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008700672",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Franklin City Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Franklin, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.