1629029483 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Table of content: DR. DENISE CAROL SEMASHKO MD (NPI 1154372720)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629029483 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:
HALIFAX COUNTY HEALTH DEPARTMENT
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:
1629029483
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 845
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HALIFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24558-0845
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-738-6545
Provider Business Mailing Address Fax Number:
434-738-6295

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 COWFORD ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HALIFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-476-4863
Provider Business Practice Location Address Fax Number:
434-476-4869
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPILLMANN
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
434-738-6545

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X , with the licence number:  1010243863 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 004975570 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4975570 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 266537 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 005840686 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25574 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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