Provider Demographics
NPI:1184728503
Name:LEWIS-GALE PHYSICIANS, LLC
Entity type:Organization
Organization Name:LEWIS-GALE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-772-3672
Mailing Address - Street 1:614 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1786
Mailing Address - Country:US
Mailing Address - Phone:540-639-2723
Mailing Address - Fax:540-639-6805
Practice Address - Street 1:614 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1786
Practice Address - Country:US
Practice Address - Phone:540-639-2723
Practice Address - Fax:540-639-6805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048225207KA0200X
VA0101044009207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Not Answered207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty