Provider Demographics
NPI:1336221787
Name:LEWIS GALE PHYSICIANS LLC
Entity Type:Organization
Organization Name:LEWIS GALE PHYSICIANS LLC
Other - Org Name:MAIN LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:CALKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-237-7766
Mailing Address - Street 1:PO BOX 403901
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3901
Mailing Address - Country:US
Mailing Address - Phone:816-701-4101
Mailing Address - Fax:
Practice Address - Street 1:1802 BRAEBURN DR
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:VA
Practice Address - Zip Code:24153-7357
Practice Address - Country:US
Practice Address - Phone:540-772-3511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004980034Medicaid
VA004980034Medicaid
VAP00311263 - RAILROADMedicare PIN