Complexions of Central Virginia, Inc.
Organization Active NPI Primary Care Clinic/Center · Lynchburg, VA
NPI 1245477223 · NPPES record last updated Mar 4, 2011
Key facts
- NPI
- 1245477223
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Primary Care Clinic/Center 261QP2300X
- License
- 0101059327 (VA)
- Legal business name
- COMPLEXIONS OF CENTRAL VIRGINIA, INC.
- Practice address
- 1922 Thomson Dr Ste B
Lynchburg, VA 24501-1020 - Phone
- (434) 846-4444
- Fax
- (434) 846-4445
- NPI assigned
- Jan 14, 2009
- Organization subpart
- No
Authorized official
- Name
- Dr. Richard A Miller, M.D.
- Title
- President
- Phone
- (434) 846-4444
Practitioners 4
-
Richard Miller, MD
-
Andrea E.P. Kittrell, M.D.
-
Cherish T Van Schaik, FNP
-
Khammany Southammavong, O.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 49D2004750 | Blue Ridge Internal Medicine CMG Thomsin Drive | Certificate of waiver | Apr 16, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in VA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090128000529 | VA | Part B Supplier - Clinic/Group Practice | 2365506888 |
Receives reassigned benefits from 3 practitioners Practice locations: Lynchburg, VA |
National Provider Directory
Locations
2900 Old Forest Rd
Lynchburg, VA 24501
Phone (434) 386-4106
1922 Thomson Dr
Ste B
Lynchburg, VA 24501
Phone (434) 846-4444
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | 0101059327 | VA | Yes |
Addresses
Primary practice location
1922 Thomson Dr Ste B
Lynchburg, VA 24501-1020
Mailing address
1922 Thomson Dr Ste B
Lynchburg, VA 24501-1020
Phone (434) 846-4444
Other names
- Blue Ridge Internal Medicine
Other providers in Lynchburg, VA
- Steven Anthony Combs
- Commonwealth of Virginia State Board of Health
- Commonwealth of Virginia State Department of Health
- Community Access Network
- Community Alternatives Virginia, Inc.
- Comprehensive Family Services, Inc.
- Annamarie Elmore Compton
- Mason G Conine
- Conjugate Physical Therapy PLLC
- Robert G. Conlon
All providers in Lynchburg, VA · Primary Care Clinic/Center in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 4, 2011. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.