Provider Demographics
NPI:1699887539
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:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CANTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:276-346-2011
Mailing Address - Street 1:P O BOX 763
Mailing Address - Street 2:HILL STREET
Mailing Address - City:JONESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24263
Mailing Address - Country:US
Mailing Address - Phone:276-346-2011
Mailing Address - Fax:276-346-0401
Practice Address - Street 1:HILL STREET
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:VA
Practice Address - Zip Code:24263
Practice Address - Country:US
Practice Address - Phone:276-346-2011
Practice Address - Fax:276-346-0401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA600000519OtherRAILROADMEDICARE
VA4975071Medicaid
VAC09066Medicare PIN
VA4975071Medicaid
VA600000519OtherRAILROADMEDICARE
VAB09328Medicare UPIN
VAS96822Medicare UPIN