# CENTRA MEDICAL GROUP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** CENTRA MEDICAL GROUP, LLC
- **Other names:** Piedmont Primecare-Centra Medical Group (DME)
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1932402484
- **Legal business name:** CENTRA MEDICAL GROUP, LLC
- **Authorized official:** LEWIS ADDISON (CFO)
- **Authorized official phone:** (434) 200-3656

## Contact information

- **Practice address:** 130 ENTERPRISE DR, DANVILLE, VA 24540-4070
- **Practice address phone:** (434) 791-2273
- **Mailing address:** 1204 FENWICK DR, LYNCHBURG, VA 24502-2112

## Taxonomy

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

## Other

- **Enumeration date:** 12/06/2010
- **Last updated:** 11/14/2012