NPIMap

Organization Active NPI

Lewis-Gale Physicians, LLC

  • Family Medicine Physician
  • Roanoke, VA
National Provider Identifier
1063484921
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101235727 Issued in VA
Legal business name
LEWIS-GALE PHYSICIANS, LLC
Practice address
4910 Valley View Blvd NW
Roanoke, VA 24012-2040
Phone
(540) 265-1607
Fax
(540) 366-7353
NPI assigned
Feb 6, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Otis Blackwood
Title
Practice Administrator
Phone
(540) 772-3671

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 0101040969 VA
Family Medicine Physician 207Q00000X 0101235727 VA Primary
Ophthalmology Physician 207W00000X 0101042126 VA

Addresses

Primary practice location

4910 Valley View Blvd NW
Roanoke, VA 24012-2040

Mailing address

4910 Valley View Blvd NW
Roanoke, VA 24012-2040
Phone (540) 265-1607

Other names 1

  • Lewis-Gale Family Care - Valley View Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0669270Lewis Gale Physicians, LLC4910 Valley View Blvd, Roanoke, VA 24012Provider-performed microscopyFeb 4, 2028

National Provider Directory

National Provider Directory
Tax ID family
Lewis-Gale Physicians LLC16 organizations share this tax ID, including this one

Other organizations with this tax ID 15

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

View all 15

Locations

4910 Valley View Blvd NW
Roanoke, VA 24012
Phone (540) 265-1600

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1063484921",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122040",
            "telephone_number": "540-265-1607",
            "fax_number": "540-366-7353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 VALLEY VIEW BLVD NW",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240122040",
            "telephone_number": "540-265-1607",
            "fax_number": "540-366-7353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEWIS-GALE PHYSICIANS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-06",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "BLACKWOOD",
        "authorized_official_first_name": "OTIS",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "540-772-3671"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101040969",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101235727",
            "primary": true
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "VA",
            "license": "0101042126",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lewis-Gale Family Care - Valley View",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.