Provider Demographics
NPI:1114999075
Name:LEWIS-GALE PHYSICIANS, LLC
Entity Type:Organization
Organization Name:LEWIS-GALE PHYSICIANS, LLC
Other - Org Name:LEWIS-GALE FAMILY CARE - CHRISTIANSBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-772-3672
Mailing Address - Street 1:2955 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-6575
Mailing Address - Country:US
Mailing Address - Phone:540-382-8886
Mailing Address - Fax:540-382-9013
Practice Address - Street 1:2955 MARKET ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-6575
Practice Address - Country:US
Practice Address - Phone:540-382-8886
Practice Address - Fax:540-382-9013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01030000975213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Multi-Specialty