Centra Medical Group Southside, LLC

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

Legal business name

CENTRA MEDICAL GROUP SOUTHSIDE, LLC

Doing business as

Centra Southside Emergency Professional Services

Practice address

800 Oak St
Farmville, VA 23901-1199

Phone

(434) 315-2530

NPI assigned

Mar 8, 2013

Last updated

Mar 8, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

CENTRA MEDICAL GROUP SOUTHSIDE, LLCAs reported in NPPES

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

Authorized official

Name

William Bass

Title

VP Coo

Phone

(434) 315-2432

Specialties & licenses 1

Addresses

Other names 1

• Centra Southside Emergency Professional Services Doing business as

Part of

Centra Medical Group Southside LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Centra Medical Group Southside, LLC

  • Family Medicine Physician
  • Farmville, VA
  • NPI 1841479565
  NPPES parent name

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

{
    "created_epoch": "1362700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362700800000",
    "number": "1174864615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1204 FENWICK DR",
            "city": "LYNCHBURG",
            "state": "VA",
            "postal_code": "245022112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OAK ST",
            "city": "FARMVILLE",
            "state": "VA",
            "postal_code": "239011199",
            "telephone_number": "434-315-2530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRA MEDICAL GROUP SOUTHSIDE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CENTRA MEDICAL GROUP SOUTHSIDE, LLC",
        "enumeration_date": "2013-03-08",
        "last_updated": "2013-03-08",
        "status": "A",
        "authorized_official_last_name": "BASS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "VP COO",
        "authorized_official_telephone_number": "434-315-2432"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Centra Southside Emergency Professional Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Bethany Carilli, DC
• Lauren Elaine Carpenter, CCC-SLP
• Norman Tortosa Carrera, OT
• Erica Green Carter, M.D.
• Centra
• Centra Medical Group Southside, LLC
• Centra Medical Group, LLC (CMG Southside Pediatric Center)
• Centra Medical Group, LLC (CMG Addiction Treatment Center Farmville)
• Centra Medical Group. LLC (CMG Southside Pulmonology)
• Centra Pace - Farmville (Centra PACE)

• Emergency Medicine Physician in Farmville, VA
• Providers in Farmville, VA by specialty
• Emergency Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.