Centra Medical Group, LLC
Organization Active NPI Colon & Rectal Surgery Physician · Lynchburg, VA
NPI 1013198779 · NPPES record last updated Oct 16, 2014
Key facts
- NPI
- 1013198779
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Colon & Rectal Surgery Physician 208C00000X
- Legal business name
- CENTRA MEDICAL GROUP, LLC
- Practice address
- 1906 Thomson Dr
Lynchburg, VA 24501-1009 - Phone
- (434) 947-3933
- NPI assigned
- Nov 21, 2007
- Organization subpart
- Yes
- Parent organization (as reported)
- CENTRA MEDICAL GROUP, LLC
Authorized official
- Name
- Lewis Addison
- Title
- Director
- Phone
- (434) 200-5047
Other NPIs on the same Medicare enrollment 37
Practitioners 10
-
Vasutakarn Chongthammakun, MD PHD
-
Amanda Gray, CRNA
-
James M Lee, MD
-
Jason Page Meador, PA-C
-
Joni Morcom, PA-C
-
Lori Ann Nelson-Madison, M. D.
-
Pamela G. Smith, M.D.
-
Kirk Darrel Peterson, M.D.
-
Laura Oliver Thomas, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051230000147 | VA | Part B Supplier - Clinic/Group Practice | 4789606088 |
Receives reassigned benefits from 865 practitioners 37 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
- Part of
- Centra Health Professional Services
Locations
1906 Thomson Dr
Lynchburg, VA 24501
Phone (434) 200-3933
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician |
208600000X | |||
| Colon & Rectal Surgery Physician |
208C00000X | Yes |
Addresses
Primary practice location
1906 Thomson Dr
Lynchburg, VA 24501-1009
Mailing address
2010 Atherholt Rd
Lynchburg, VA 24501-1106
Other names
- Centra Medical Group Surgical Specialists
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All providers in Lynchburg, VA · Colon & Rectal Surgery Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 16, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.