NPIMap

Centra Medical Group, LLC

Organization Active NPI Child & Adolescent Psychiatry Physician · Lynchburg, VA

NPI 1609818293 · NPPES record last updated Jan 15, 2014

Key facts

NPI
1609818293
Entity type
Organization (NPI type 2)
Primary specialty
Child & Adolescent Psychiatry Physician 2084P0804X
Legal business name
CENTRA MEDICAL GROUP, LLC
Practice address
693 Leesville Rd
Lynchburg, VA 24502-2828
Phone
(434) 200-5700
NPI assigned
Jun 11, 2006
Organization subpart
Yes
Parent organization (as reported)
CENTRA MEDICAL GROUP, LLC

Authorized official

Name
Lewis Addison
Title
Sr VP Cfo
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) 24

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

Locations

140 Vista Centre Dr
Fl 2
Forest, VA 24551
Phone (434) 200-2297

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Child & Adolescent Psychiatry Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 2084P0804X Yes

Addresses

Primary practice location

693 Leesville Rd
Lynchburg, VA 24502-2828

Mailing address

2010 Atherholt Rd
Lynchburg, VA 24501-1106

Other names

  • Autism Diagnostic Center Doing business as

Other providers in Lynchburg, VA

All providers in Lynchburg, VA · Child & Adolescent Psychiatry Physician in Virginia

Sources for this page

Verify at the official NPI Registry.