CENTRA MEDICAL GROUP SOUTHSIDE LLC NPI 1841479565

NPI Information

NPI: 1841479565
Provider Name: CENTRA MEDICAL GROUP SOUTHSIDE, LLC
Classification: Family Medicine - 207Q00000X
Entity Type: Organization
Address:
800 OAK ST
FARMVILLE, VA
ZIP 23901
Phone: (434) 200-3656
Get Directions

CENTRA MEDICAL GROUP SOUTHSIDE, LLC is a family medicine in Farmville, VA. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. CENTRA MEDICAL GROUP SOUTHSIDE, LLC NPI is 1841479565. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

800 OAK ST
FARMVILLE, VA
ZIP 23901-199
Phone: (434) 200-3656

The provider's authorized official is William Bass .
The authorized official title is Cfo and has the following contact phone number (434) 392-8811.

The enumeration date for this NPI number is 10/30/2007 and was last updated on 8/7/2014.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	207R00000X	Internal Medicine		No
2	207RE0101X	Internal Medicine	Endocrinology, Diabetes & Metabolism	No
3	2084N0400X	Psychiatry & Neurology	Neurology	No
4	208600000X	Surgery		No
5	207Q00000X	Family Medicine		Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	61459604	OTHER	VIRGINIA	BLACK LUNG/FECA (1418 6TH ST)
2	345606	OTHER	VIRGINIA	ANTHEM BCBS (412 NAMOZINE STREET)
3	61459602	OTHER	VIRGINIA	BLACK LUNG/FECA (412 NAMOZINE STR)
4	61459600	OTHER	VIRGINIA	BLACK LUNG/FECA (STE 3105)
5	1841479565	MEDICAID	VIRGINIA
6	345604	OTHER	VIRGINIA	ANTHEM BCBS (800 OAK STREET)
7	61459601	OTHER	VIRGINIA	BLACK LUNG/FECA (312 KING ST)
8	345307	OTHER	VIRGINIA	ANTHEM, BCBS (1418 6TH STREET)
9	345608	OTHER	VIRGINIA	ANTHEM BCBS (312 KING STREET)
10	9978134	OTHER	VIRGINIA	AETNA
11	61459603	OTHER	VIRGINIA	BLACK LUNG/FECA (1705 3RD ST)
12	DN1489	MEDICARE PIN	VIRGINIA
13	C10459	MEDICARE PIN	VIRGINIA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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