Provider Demographics
NPI:1801187547
Name:CENTRA HEALTH, INC
Entity Type:Organization
Organization Name:CENTRA HEALTH, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEPHROLOGY NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:VIGNALI
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, RN, CCRN, ACNPC
Authorized Official - Phone:434-200-3000
Mailing Address - Street 1:1901 TATE SPRINGS ROAD
Mailing Address - Street 2:LYNCHBURG GENERAL HOSPITAL--DIABETIC-RENAL MEDICAL UNIT
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501
Mailing Address - Country:US
Mailing Address - Phone:434-200-3000
Mailing Address - Fax:434-200-7368
Practice Address - Street 1:1901 TATE SPRINGS RD
Practice Address - Street 2:LYNCHBURG GENERAL HOSPITAL--DIABETIC-RENAL MEDICAL UNIT
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1109
Practice Address - Country:US
Practice Address - Phone:434-200-3000
Practice Address - Fax:434-200-7368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital