# CENTRA MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1164720058
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** LEWIS ADDISON (SR VP, CFO)
- **Authorized official phone:** (434) 200-3656

## Contact information

- **Practice address:** 1280A MAIN ST, ALTAVISTA, VA 24517-1465
- **Practice address phone:** (434) 309-1165
- **Mailing address:** 1204 FENWICK DR, LYNCHBURG, VA 24502-2112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 03/02/2011
- **Last updated:** 11/14/2012