Basic Information
| Provider Information | |||||||||
| NPI: | 1265015580 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AUGUSTA MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 COMFORT WAY STE 1 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244503788 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 55 COMFORT WAY STE 1 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 244503788 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404633381 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2021 | ||||||||
| LastUpdateDate: | 05/04/2021 | ||||||||
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| AuthorizedOfficialLastName: | JUST | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5402457318 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | AUGUSTA HEALTH CARE, INC. | ||||||||
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| NPICertificationDate: | 05/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.