Provider Demographics
NPI:1922122605
Name:LYNCHBURG RHEUMATOLOGY CLINIC
Entity Type:Organization
Organization Name:LYNCHBURG RHEUMATOLOGY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:WELLINGTON
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-947-5918
Mailing Address - Street 1:2025 TATE SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-1116
Mailing Address - Country:US
Mailing Address - Phone:434-947-5918
Mailing Address - Fax:434-947-5923
Practice Address - Street 1:2025 TATE SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-1116
Practice Address - Country:US
Practice Address - Phone:434-947-5918
Practice Address - Fax:434-947-5923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030315174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB07520Medicare UPIN
VAC04445Medicare ID - Type Unspecified