CENTRA MEDICAL GROUP, LLC (NPI# 1609818293) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1609818293 |
Entity Type | Organization |
Organization Name | CENTRA MEDICAL GROUP, LLC |
Other Organization Name | AUTISM DIAGNOSTIC CENTER |
Practice Address |
693 Leesville Rd Lynchburg VA 24502-2828 |
Mailing Address |
2010 Atherholt Rd Lynchburg VA 24501-1106 |
Practice Telephone | 4342005700 |
Enumeration Date | 2006-06-11 |
Last Update Date | 2014-01-15 |
Authorized Official Name | LEWIS ADDISON (SR VP CFO) |
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 | 2084P0804X |
Psychiatry & Neurology Specialization: Child & Adolescent Psychiatry |
Allopathic & Osteopathic Physicians |
Other Name | Type Code |
---|---|
Autism Diagnostic Center | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326682980 | Centra Medical Group, LLC | Family Medicine | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2019-11-06 |
1144880782 | Centra Medical Group, LLC | Surgery | 2410 Atherholt Rd, Lynchburg, VA 24501-2148 | 2019-06-17 |
1932685526 | Centra Medical Group, LLC | Anesthesiology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2018-07-17 |
1548750052 | Centra Medical Group, LLC | Family Medicine | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 | 2018-05-10 |
1376033886 | Centra Medical Group, LLC | Family Medicine | 1901 Tate Springs Rd, Lynchburg, VA 24501-1109 | 2018-05-10 |
1912434663 | Centra Medical Group, LLC | Family Medicine | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2017-05-12 |
1518315902 | Centra Medical Group, LLC | Clinic/Center | 125 Nationwide Drive, Lynchburg, VA 24502-9998 | 2016-05-26 |
1649624164 | Centra Medical Group, LLC | Psychologist | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2016-04-21 |
1003260522 | Centra Medical Group, LLC | Anesthesiology | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2016-04-21 |
1295104347 | Centra Medical Group, LLC | Internal Medicine | 1613 Oakwood St, Suite 201, Bedford, VA 24523-1213 | 2015-09-18 |
Street Address |
693 LEESVILLE RD |
City | LYNCHBURG |
State | VA |
Zip Code | 24502-2828 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1215938972 | Ellis M. Karr | Social Worker | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2005-08-03 |
1376144931 | Nelly Addo | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-11-02 |
1366057531 | Margaret Rose Hybl | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-09-14 |
1427662261 | Samantha Clingenpeel | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-08-31 |
1952915712 | Jessica Stinnett Cunningham | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-08-31 |
1346850948 | Nikki Rice | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-08-07 |
1912516642 | Stephannie Malone | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-07-29 |
1265041552 | Jeffrey Emmett Mccurry | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-07-23 |
1164044863 | Amanda Mae Dinkle | Behavior Technician | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-05-15 |
1366063026 | Heather Ware | Behavioral Analyst | 693 Leesville Rd, Lynchburg, VA 24502-2828 | 2020-05-04 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811523038 | Vivian Tran | Student in an Organized Health Care Education/Training Program | Liberty University College of Osteopathic Medicine, 306 Liberty View Ln, Lynchburg, VA 24502 | 2020-03-19 |
1669005468 | Beth Elaine Hammond | Nurse Practitioner | 132 Frederick Drive, Lynchburg, VA 24502 | 2020-02-20 |
1225672348 | Pearlren-aye Elizabeth Taylor | Case Management | 542 Leesville Rd, Apt 127, Lynchburg, VA 24502 | 2019-10-31 |
1821553868 | Shavonne D Joyner | Behavioral Analyst | 18697 Forest Road, Lynchburg, VA 24502 | 2019-02-04 |
1043794415 | Robert Patrick Thomas | Private Vehicle | 44 Point Drive, Apt 30, Lynchburg, VA 24502 | 2018-09-20 |
1023503521 | Ptc Wellness Centers PC | Family Medicine | 2832 Candlers Mtn Rd, Lynchburg, VA 24502 | 2018-06-27 |
1548750722 | Raymond W Andrews IIi | Speech-Language Pathologist | 3101 Wards Ferry Road, Lynchburg, VA 24502 | 2018-05-14 |
1932697596 | Barbara J Frost | Nurse Practitioner | 906 Westview Dr, Lynchburg, VA 24502 | 2018-04-28 |
1619476983 | Benjamin Aaron Galley | Specialist/Technologist | 1971 University Blvd., Lynchburg, VA 24502 | 2018-02-01 |
1477076180 | Candice Cage | Home Health | 1002 Wexford Place, Lynchburg, VA 24502 | 2017-07-25 |
Find all providers in zip 24502 |
Taxonomy Code | 2084P0804X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Psychiatry & Neurology |
Specialization | Child & Adolescent Psychiatry |
Child & Adolescent Psychiatry is a subspecialty of psychiatry with additional skills and training in the diagnosis and treatment of developmental, behavioral, emotional, and mental disorders of childhood and adolescence. |
Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1831592369 | Onaiza Anees | Psychiatry & Neurology | 2215 Langhorne Rd, Lynchburg, VA 24501-1121 | 2014-09-29 |
1235480351 | Centra Health Professional Services, LLC | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2012-09-28 |
1083908958 | Jitendra Annapareddy | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2011-06-08 |
1134364151 | Namita Dhiman | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2008-12-04 |
1750547915 | Lakshman Sudhir Gandham | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503 | 2008-08-06 |
1154517670 | Tiffany Kuulei Niide | Psychiatry & Neurology | 2010 Atherholt Rd, Lynchburg, VA 24501-1106 | 2007-09-18 |
1154412344 | James G Kavanaugh Jr. | Psychiatry & Neurology | 2215 Langhorne Rd, Suite 104, Lynchburg, VA 24501-1121 | 2006-09-27 |
1366443434 | Edward John Kuhnley | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2005-08-10 |
1699775593 | John L. Hendrickson | Psychiatry & Neurology | 3300 Rivermont Ave, Lynchburg, VA 24503-2030 | 2005-07-21 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1902248073 | Tanvir Iqbal | Psychiatry & Neurology | 201 S Main St Ste 3400, Danville, VA 24541-2932 | 2013-07-18 |
1821364043 | Michael Kubelik Heck | Psychiatry & Neurology | 691 Berkmar Cir, Charlottesville, VA 22901-1464 | 2012-04-02 |
1831403864 | Neel Nene | Psychiatry & Neurology | 801 N Quincy St Ste 601, Arlington, VA 22203-1729 | 2010-08-02 |
1295048684 | My Psychiatrist, Plc | Psychiatry & Neurology | 12359 Sunrise Valley Dr Ste 320, Herndon, VA 20191-3463 | 2010-07-14 |
1023257979 | Kevin Michael Williams | Psychiatry & Neurology | 3737 Seminary Rd, Alexandria, VA 22304-5202 | 2009-02-17 |
1881854982 | John Paul Steg | Psychiatry & Neurology | 6760 Old Mclean Village Dr, Mc Lean, VA 22101-3906 | 2008-06-11 |
1336343516 | Nelson Lugo | Psychiatry & Neurology | 43330 Junction Plz Ste 160, Pmb 108, Ashburn, VA 20147-3408 | 2007-06-12 |
1598973471 | Charles E Hall Iv | Psychiatry & Neurology | 100 Boulders Pkwy, Suite 202, Richmond, VA 23225 | 2007-05-21 |
1699983692 | Heather Kilbride Henig | Psychiatry & Neurology | 11490 Commerce Park Dr Ste 420, Reston, VA 20191 | 2007-05-21 |
1104942754 | William Louis Licamele | Psychiatry & Neurology | 6760 Old Mclean Village Dr., Mclean, VA 22101-3906 | 2007-03-22 |
Find all providers with the same taxonomy |
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.