# CENTRA HEALTH INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Centra Health Physician Provider Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205357506
- **Authorized official:** JOE Z KOONS (MANAGING DIRECTOR REVENUE CYCLE)
- **Authorized official phone:** (434) 200-4758

## Contact information

- **Practice address:** 3300 RIVERMONT AVE, LYNCHBURG, VA 24503-2030
- **Practice address phone:** (434) 200-4758
- **Mailing address:** 1204 FENWICK DR, LYNCHBURG, VA 24502-2112
- **Mailing address phone:** (434) 200-4758
- **Mailing address fax:** (434) 200-4763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RH0003X | Hematology & Oncology Physician | — | NULL | — |
| 207RH0003X | Hematology & Oncology Physician | — | — | — |
| 2084P0800X | Psychiatry Physician | — | NULL | — |
| 2084P0800X | Psychiatry Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/28/2017
- **Last updated:** 06/28/2017