Provider Demographics
NPI:1306950753
Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Entity type:Organization
Organization Name:COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NOELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-381-7100
Mailing Address - Street 1:210 S PEPPER STREET
Mailing Address - Street 2:SUITE A
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-3522
Mailing Address - Country:US
Mailing Address - Phone:540-381-7100
Mailing Address - Fax:540-381-7108
Practice Address - Street 1:210 PEPPER ST S
Practice Address - Street 2:SUITE A
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-3571
Practice Address - Country:US
Practice Address - Phone:540-381-7100
Practice Address - Fax:540-381-7108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975146Medicaid
VA004975146Medicaid
VA10001611OtherSENTARA/OPTIMA
VA412912OtherSOUTHERN HEALTH
VA266495OtherANTHEM/BC/HEALTHKEEPERS
VA600699126Medicare PIN