Basic Information
| Provider Information | |||||||||
| NPI: | 1508932088 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRA HEALTH CARDIOVASCULAR SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11709 | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245061709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349475252 | ||||||||
| FaxNumber: | 4348473645 | ||||||||
| Practice Location | |||||||||
| Address1: | 2410 ATHERHOLT RD | ||||||||
| Address2: | |||||||||
| City: | LYNCHBURG | ||||||||
| State: | VA | ||||||||
| PostalCode: | 245012148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349475252 | ||||||||
| FaxNumber: | 4348473645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | COLEMAN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 4349475252 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.