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General NPI Number Information
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NPI Number | 1144501859
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Entity Type | Organization
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Legal Business Name | CENTRA HEALTH PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 09/08/2011
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Last Update Date | 09/15/2011
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Provider Practice Location Address
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Address Line | 3300 RIVERMONT AVE
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City | LYNCHBURG
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State | VA
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Zip | 24503-2030
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Country | US
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Telephone | 434-200-4628
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Fax |
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Provider Business Mailing Address
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Address Line | 1204 FENWICK DR
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City | LYNCHBURG
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State | VA
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Zip | 24502-2112
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP PHYSICIAN PRACTICE MANAGEMENT
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Name | ARTHUR LEAVITT
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Credential |
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Telephone | 434-200-3656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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