Organization
LEWIS-GALE PHYSICIANS, LLC
Active
Other names
Lewis-Gale Family Care - Bonsack
Organization subpart
No
Provider details
NPI number
Authorized official
OTIS BLACKWOOD (PRACTICE ADMINISTRATOR)
(540) 772-3672
Entity
Organization
Contact information
Practice address
4615 HUNTRIDGE RD, ROANOKE, VA 24012-8510
(540) 977-0990
(540) 977-0550
Mailing address
4615 HUNTRIDGE RD, ROANOKE, VA 24012-8510
(540) 977-0990
(540) 977-0550
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101051150
VA
207R00000X
Internal Medicine Physician
0101054814
VA
208000000X
Pediatrics Physician
Primary
0101036280
VA
Other
Enumeration date
02/06/2006
Last updated
09/11/2025
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