1447341417 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Table of content: (NPI 1447341417)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447341417 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HENRICO COUNTY HEALTH DEPARTMENT WEST
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447341417
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/10/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 90775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENRICO
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23273-0775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-501-4953
Provider Business Mailing Address Fax Number:
804-501-4588

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8600 DIXON POWERS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENRICO
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23228-2735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-501-4953
Provider Business Practice Location Address Fax Number:
804-501-4588
Provider Enumeration Date:
09/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BENNETT
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
804-501-4953

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4975588 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 072212 . This is a "ANTHEM HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10001587 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68428 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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