CENTRA MEDICAL GROUP. LLC (NPI# 1336638865) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336638865 |
| Entity Type | Organization |
| Organization Name | CENTRA MEDICAL GROUP. LLC |
| Other Organization Name | CMG SOUTHSIDE PULMONOLOGY |
| Practice Address |
800 Oak St Farmville VA 23901-1199 |
| Mailing Address |
1937 Thomson Dr Lynchburg VA 24501-1008 |
| Practice Telephone | 4343152880 |
| Enumeration Date | 2018-05-10 |
| Last Update Date | 2018-05-10 |
| Authorized Official Name | JOSHUA LARKIN (PAYER CREDENTIALING MANAGER) |
| Authorized Official Telephone | 4342005047 |
| Is Organization Subpart | Y |
| Parent Organization Name | CENTRA MEDICAL GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| CMG Southside Pulmonology | Doing Business As Name - Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | Centra Medical Group Bedford LLC | 1901 Tate Springs Road, Lynchburg, Virginia 24501 |
| Virginia Business Entities | CENTRA MEDICAL GROUP LLC | 2010 Atherholt Road, Lynchburg, Virginia 24501 |
| Virginia Business Entities | Centra Medical Group Southside LLC | 800 Oak St, Farmville, Virginia 23901 |
| Street Address |
800 OAK ST |
| City | FARMVILLE |
| State | VA |
| Zip Code | 23901-1199 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164427142 | Jill Ann Frances | Specialist | 800 Oak St, Farmville, VA 23901-1199 | 2005-06-16 |
| 1538760350 | Elizabeth Ann Bedell | Internal Medicine | 800 Oak St, Farmville, VA 23901-1199 | 2020-11-06 |
| 1083259931 | Jamie Ford | Behavior Technician | 800 Oak St, Farmville, VA 23901-1199 | 2019-11-14 |
| 1952946527 | Linda Latise Murphy | Behavior Technician | 800 Oak St, Farmville, VA 23901-1199 | 2019-11-07 |
| 1679117279 | Dequan Lamar Smith | Behavior Technician | 800 Oak St, Farmville, VA 23901-1199 | 2019-11-06 |
| 1083257307 | Akeem Howell | Behavior Technician | 800 Oak St, Farmville, VA 23901-1199 | 2019-10-18 |
| 1609418177 | Tracy N Davis | Behavior Technician | 800 Oak St, Farmville, VA 23901-1199 | 2019-10-16 |
| 1588205777 | Brittany Alexis Brown | Speech-Language Pathologist | 800 Oak St, Farmville, VA 23901-1199 | 2019-09-30 |
| 1174176812 | Kyle Michael Eriks-cline | Nurse Practitioner | 800 Oak St, Farmville, VA 23901-1199 | 2019-07-22 |
| 1992367064 | Curtis L Stowers | Clinical Nurse Specialist | 800 Oak St, Farmville, VA 23901-1199 | 2019-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245876531 | Farmville Family Pharmacy, Inc. | Pharmacy | 1538 South Main Street, Farmville, VA 23901 | 2019-11-21 |
| 1184269870 | Louis Lee Huddleston | Counselor | 502 Beech Street, Farmville, VA 23901 | 2019-11-17 |
| 1447706668 | Alison Cameron | Specialist/Technologist | 3152 Allen Farm Road, Farmville, VA 23901 | 2016-08-28 |
| 1508236977 | Sarah Trimble | Social Worker | 833 Buffalo Street Suite 200, Suite 200 Po Drawer Q, Farmville, VA 23901 | 2015-09-29 |
| 1437532306 | Tara Ross-barksdale | Counselor | 129 Walnut Lane, Farmville, VA 23901 | 2015-07-09 |
| 1770997660 | Ronda L Walker | Speech-Language Pathologist | 315 West Third Street, Farmville, VA 23901 | 2014-06-18 |
| 1598191165 | Stephen Stone | Physician Assistant | 1706 East 3rd Street, Farmville, VA 23901 | 2013-09-16 |
| 1558637611 | Jeffrey Sargent | Physical Therapy Assistant | 800 0ak St, Farmville, VA 23901 | 2012-03-22 |
| 1497068217 | Family Preservation Services, Inc. | Community/Behavioral Health | 1825 East Third Street, Farmville, VA 23901 | 2010-07-21 |
| 1467781419 | Aime Spencer | Counselor | 232 Ridgeway Drive, Farmville, VA 23901 | 2009-12-21 |
| Find all providers in zip 23901 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932587243 | Southside Area Family Medicine Inc | Family Medicine | 324 Commerce Rd Ste A, Farmville, VA 23901-2794 | 2015-05-07 |
| 1932209335 | Timothy Wiley Corbett Sr. | Family Medicine | 324 Commerce Rd, Suite A, Farmville, VA 23901-2794 | 2006-09-25 |
| 1497765473 | Lawrence C Varner | Family Medicine | 400 Longwood Ave, Farmville, VA 23901-1524 | 2006-08-09 |
| 1497717342 | Enrique Villa Marana | Family Medicine | 3485 N Main St, Farmville, NC 27828-1466 | 2006-04-05 |
| 1730167099 | David E Pruitt | Family Medicine | 935 S Main St, Farmville, VA 23901-2211 | 2006-01-06 |
| 1154309334 | Robert C Wade | Family Medicine | 1705 East Third Street, Farmville, VA 23901-1199 | 2006-01-06 |
| 1053313957 | Edwina C Wilson | Family Medicine | 833 Buffalo St, Suite 200, Farmville, VA 23901-1111 | 2005-08-11 |
| 1295389849 | Carly Elizabeth Haddock | Family Medicine | 935 S Main St, Farmville, VA 23901-2211 | 2019-07-31 |
| 1710235544 | Ranjit Singh | Family Medicine | 935 S Main St, Farmville, VA 23901-2211 | 2012-08-28 |
| 1831404524 | Giuliana Allega | Family Medicine | 935 S Main St, Farmville, VA 23901-2211 | 2010-08-18 |
| Find all providers in FARMVILLE | ||||
Please comment or provide details below to improve the information on CENTRA MEDICAL GROUP. LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.