| Organization Name: | LEWIS-GALE PHYSICIANS, LLC |
| NPI Number: | 1184728503 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | OTIS W BLACKWOOD (PRACTICE ADMINISTRATOR) |
| Mailing Address: | 614 E Main St Radford |
| State: | VA US |
| Postal Code: | 241411786 |
| Phone Number: | 5406392723 |
| Fax Number: | 5406396805 |
| NPI Enumeration Date: | 09/08/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207KA0200X |
| License Number: | 0101048225 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Allergy & Immunology |
| Taxonomy Specialization: | Allergy |
| Taxonomy Definition: | |