CENTRA MEDICAL GROUP LLC NPI 1164720058

NPI Information

NPI: 1164720058
Provider Name: CENTRA MEDICAL GROUP, LLC

Doing Business As: ALTAVISTA MEDICAL CENTER RHC

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
1280A MAIN ST
ALTAVISTA, VA
ZIP 24517
Phone: (434) 309-1165
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CENTRA MEDICAL GROUP, LLC is a rural health clinic center in Altavista, VA. CENTRA MEDICAL GROUP, LLC NPI is 1164720058. The provider is registered as an organization entity type.
The provider Is Doing Business As Altavista Medical Center Rhc.

The provider's business location address is:

1280A MAIN ST
ALTAVISTA, VA
ZIP 24517-465
Phone: (434) 309-1165

The provider's authorized official is Lewis Addison .
The authorized official title is Sr Vp, Cfo and has the following contact phone number (434) 200-3656.

The enumeration date for this NPI number is 3/2/2011 and was last updated on 11/14/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C09704	MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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