Provider Demographics
NPI:1902813231
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:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BONDS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:434-972-6219
Mailing Address - Street 1:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:LOUISA
Mailing Address - State:VA
Mailing Address - Zip Code:23093-0336
Mailing Address - Country:US
Mailing Address - Phone:540-967-3703
Mailing Address - Fax:540-967-3706
Practice Address - Street 1:540 INDUSTRIAL DR
Practice Address - Street 2:
Practice Address - City:LOUISA
Practice Address - State:VA
Practice Address - Zip Code:23093
Practice Address - Country:US
Practice Address - Phone:540-967-3703
Practice Address - Fax:540-967-3706
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMONWEALTH OF VIRGINIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-01
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA266539OtherANTHEM
VA004975685Medicaid
VA008450421Medicaid
VA42013OtherOPTIMA
VA008450421Medicaid
VA004975685Medicaid