Organization
CENTRA MEDICAL GROUP SOUTHSIDE, LLC
Active
Parent organization
CENTRA MEDICAL GROUP SOUTHSIDE, LLC
Other names
Centra Southside Emergency Professional Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
CENTRA MEDICAL GROUP SOUTHSIDE, LLC
Authorized official
WILLIAM BASS (VP COO)
(434) 315-2432
Entity
Organization
Contact information
Practice address
800 OAK ST, FARMVILLE, VA 23901-1199
(434) 315-2530
Mailing address
1204 FENWICK DR, LYNCHBURG, VA 24502-2112
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Enumeration date
03/08/2013
Last updated
03/08/2013
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