1851492599 NPI number — CENTRA HEALTH INC

Table of content: (NPI 1851492599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851492599 NPI number — CENTRA HEALTH INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRA HEALTH INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PHYSICAL AND OCCUPATIONAL THERAPY
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851492599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2496
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LYNCHBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24505-2496
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-947-3777
Provider Business Mailing Address Fax Number:
434-947-4763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1204 FENWICK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LYNCHBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24502-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-947-3777
Provider Business Practice Location Address Fax Number:
434-947-4763
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADDISON
Authorized Official First Name:
LEWIS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SRVP/CFO
Authorized Official Telephone Number:
434-947-4708

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  H1911 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 189963 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 189959 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 189972 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 189990 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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