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General NPI Number Information
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NPI Number | 1144331885
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Entity Type | Organization
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Legal Business Name | LEWIS-GALE PHYSICIANS, LLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 230 S MAIN ST
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-1709
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Country | US
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Telephone | 540-483-3100
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Fax | 540-483-3115
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Provider Business Mailing Address
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Address Line | 230 S MAIN ST
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City | ROCKY MOUNT
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State | VA
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Zip | 24151-1709
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Country | US
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Telephone | 540-483-3100
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Fax | 540-483-3115
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | OTIS W BLACKWOOD
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Credential |
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Telephone | 540-772-3672
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number | 0101018545
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License Number State | VA
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