# CENTRA MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1295104347
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** JOSEPH KOONS (MANAGING DIRECTOR)
- **Authorized official phone:** (434) 200-5047

## Contact information

- **Practice address:** 1613 OAKWOOD ST, SUITE 201, BEDFORD, VA 24523-1213
- **Practice address phone:** (540) 586-7273
- **Mailing address:** 2010 ATHERHOLT RD, LYNCHBURG, VA 24501-1106

## 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:** 09/18/2015
- **Last updated:** 09/18/2015