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General NPI Number Information
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NPI Number | 1184964124
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Entity Type | Organization
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Legal Business Name | CENTRA MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 02/28/2013
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Last Update Date | 07/03/2013
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Provider Practice Location Address
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Address Line | 2410 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-2148
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Country | US
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Telephone | 434-200-5252
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Fax |
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Provider Business Mailing Address
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Address Line | 2010 ATHERHOLT RD
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City | LYNCHBURG
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State | VA
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Zip | 24501-1106
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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 | SR VP CFO
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Name | LEWIS ADDISON
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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 | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number |
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License Number State |
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