Commonweatlh of Virginia State Board of Health
Organization Active NPI Public Health or Welfare Agency · Gloucester, VA
NPI 1992767131 · NPPES record last updated Mar 19, 2012
Key facts
- NPI
- 1992767131
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- Legal business name
- COMMONWEATLH OF VIRGINIA STATE BOARD OF HEALTH
- Practice address
- 6882 Main Street
Gloucester, VA 23061-0663 - Phone
- (804) 758-2381
- Fax
- (804) 758-4828
- NPI assigned
- Apr 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Sherry House
- Title
- Administrator
- Phone
- (804) 758-2381
Corporate family (same tax ID) 13
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
Locations
9228 George Washington Memorial Hwy
Gloucester, VA 23061
Phone (804) 693-5057
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | Yes |
Addresses
Primary practice location
6882 Main Street
Gloucester, VA 23061-0663
Mailing address
PO Box 663
Gloucester, VA 23061-0663
Phone (804) 758-2381
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 004975529 | Medicaid | VA | |
| 41161 | Other | VA | SENTARA |
| 1992767131 | Other | VA | HUMANA GOLD CHOICE |
| 266546 | Other | VA | ANTHEM |
| 41161 | Other | VA | OPTIMA |
Other names
- GLOUCESTER COUNTY HEALTH DEPARTMENT
Other providers in Gloucester, VA
- Elizabeth A. Clemmons
- William Clinger
- John Cochran
- Joshua A Coleman
- Erica Colson
- Elizabeth Heather Congrove
- Megan Connelly Grothaus
- Connex Family Services
- Natalie Conway
- Courthouse Family Medicine, PLLC
All providers in Gloucester, 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.