# CENTRA HEALTH PROFESSIONAL SERVICES, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRA MEDICAL GROUP, LLC
- **Other names:** Centra Health Medical Center-Danville
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1043662828
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** JOSHUA LARKIN (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (434) 200-5047

## Contact information

- **Practice address:** 414 PARK AVENUE, DANVILLE, VA 24541-9998
- **Practice address phone:** (434) 791-1562
- **Mailing address:** 414 PARK AVENUE, DANVILLE, VA 24541-9998

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 07/06/2016
- **Last updated:** 07/06/2016