Provider Demographics
NPI:1700234580
Name:LEWISGALE MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:LEWISGALE MEDICAL CENTER, LLC
Other - Org Name:LEWISGALE DALEVILLE IMAGING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-4125
Mailing Address - Street 1:65 SHENANDOAH AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DALEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24083-3252
Mailing Address - Country:US
Mailing Address - Phone:540-966-6620
Mailing Address - Fax:540-966-6659
Practice Address - Street 1:65 SHENANDOAH AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:DALEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24083-3252
Practice Address - Country:US
Practice Address - Phone:540-966-6620
Practice Address - Fax:540-966-6659
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWISGALE MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-06-02
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)