Provider Demographics
NPI:1568722072
Name:CENTRA HEALTH, INC.
Entity Type:Organization
Organization Name:CENTRA HEALTH, INC.
Other - Org Name:VIRGINIA BAPTIST HOSPITAL POST ACUTE PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:HOSPITAL PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TABITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CULBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-200-3014
Mailing Address - Street 1:1331 OAK LN
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-2501
Mailing Address - Country:US
Mailing Address - Phone:434-200-2422
Mailing Address - Fax:434-384-3168
Practice Address - Street 1:1331 OAK LN
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-2501
Practice Address - Country:US
Practice Address - Phone:434-200-2422
Practice Address - Fax:434-384-3168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-18
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336L0003X
VA02010044553336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy
No333600000XSuppliersPharmacy
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1568722072Medicaid
4843822OtherNCPDP PROVIDER IDENTIFICATION NUMBER