NPIMap

Organization Active NPI

Commonwealth of Virginia State Board of Health

Doing business as Isle of Wight Health Department

  • State or Local Public Health Clinic/Center
  • Smithfield, VA
National Provider Identifier
1982679874
Registry record updated May 23, 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
Isle of Wight Health Department
Practice address
919 S Church St
Smithfield, VA 23430-1715
Phone
(757) 357-4177
Fax
(757) 357-2838
NPI assigned
Feb 22, 2006
Last updated
May 23, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 23, 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

919 S Church St
Smithfield, VA 23430-1715

Mailing address

919 S Church St
Smithfield, VA 23430-1715
Phone (757) 357-4177

Other identifiers 4

IdentifierTypeStateIssuer
8450811MedicaidVA
4975618OtherCLINIC
008700656OtherVAPERSONAL CARE
008770310MedicaidVA

Other names 1

  • Isle of Wight 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 16

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

View all 16

Locations

748 Battlefield Blvd N
Chesapeake, VA 23320
Phone (757) 382-8600

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": "1306108800000",
    "number": "1982679874",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "919 S CHURCH ST",
            "city": "SMITHFIELD",
            "state": "VA",
            "postal_code": "234301715",
            "telephone_number": "757-357-4177",
            "fax_number": "757-357-2838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "919 S CHURCH ST",
            "city": "SMITHFIELD",
            "state": "VA",
            "postal_code": "234301715",
            "telephone_number": "757-357-4177",
            "fax_number": "757-357-2838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-05-23",
        "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": "8450811",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLINIC",
            "identifier": "4975618",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PERSONAL CARE",
            "identifier": "008700656",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008770310",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Isle of Wight Health Department",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Smithfield, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 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.