NPIMap

Centra Health Professional Services, LLC

Organization Active NPI Family Medicine Physician · Danville, VA

NPI 1043662828 · NPPES record last updated Jul 6, 2016

Key facts

NPI
1043662828
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
CENTRA HEALTH PROFESSIONAL SERVICES, LLC
Practice address
414 Park Avenue
Danville, VA 24541-9998
Phone
(434) 791-1562
NPI assigned
Jul 6, 2016
Organization subpart
Yes
Parent organization (as reported)
CENTRA MEDICAL GROUP, LLC

Authorized official

Name
Joshua Larkin
Title
Credentialing Specialist
Phone
(434) 200-5047

Other NPIs on the same Medicare enrollment 37

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 37

Corporate family (same tax ID) 16

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
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

Tax ID family
Centra Health Professional Services (106 organizations share this tax ID)
Part of
Centra Health Professional Services

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207R00000X

Addresses

Primary practice location

414 Park Avenue
Danville, VA 24541-9998

Mailing address

414 Park Avenue
Danville, VA 24541-9998

Other names

  • Centra Health Medical Center-Danville Other name

Other providers in Danville, VA

All providers in Danville, VA · Family Medicine Physician in Virginia

Sources for this page

Verify at the official NPI Registry.