Provider Demographics
NPI:1407256274
Name:CENTRA HEALTH, INC.
Entity Type:Organization
Organization Name:CENTRA HEALTH, INC.
Other - Org Name:GRETNA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:EW
Authorized Official - Middle Name:
Authorized Official - Last Name:TIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MBA
Authorized Official - Phone:434-200-4705
Mailing Address - Street 1:PO BOX 2496
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24505-2496
Mailing Address - Country:US
Mailing Address - Phone:434-200-4758
Mailing Address - Fax:434-200-4763
Practice Address - Street 1:291 MCCBRIDE LANE
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-0291
Practice Address - Country:US
Practice Address - Phone:434-656-1274
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAH1870282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA490021Medicare PIN