1851430821 NPI number — COMMONWEALTH OF VIRGINIA STATE BOARD OF HEALTH

Table of content: (NPI 1851430821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851430821 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:
SOUTHWEST VIRGINIA CHILD DEVELOPMENT CLINIC
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:
1851430821
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/12/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
190 BEECH ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
GATE CITY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24251-3623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
276-386-1312
Provider Business Mailing Address Fax Number:
276-386-2116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
190 BEECH STREET
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
GATE CITY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
25251-3623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
276-386-1312
Provider Business Practice Location Address Fax Number:
276-386-2116
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CANTRELL
Authorized Official First Name:
ELEANOR
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
HEALTH DIRECTOR
Authorized Official Telephone Number:
276-328-8000

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)





Copyright © 2007-2024 www.npivalidator.com