Provider Demographics
NPI:1548352602
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:DISTRICT BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:H
Authorized Official - Last Name:LOVETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:276-638-2311
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:VA
Mailing Address - Zip Code:24151-0249
Mailing Address - Country:US
Mailing Address - Phone:540-484-0292
Mailing Address - Fax:540-484-0314
Practice Address - Street 1:365 PELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:VA
Practice Address - Zip Code:24151
Practice Address - Country:US
Practice Address - Phone:540-484-0292
Practice Address - Fax:540-484-0314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004975138Medicaid
VA266560OtherANTHEM
VAC08716Medicare PIN