| Organization Name: | LEWISGALE MEDICAL CENTER, LLC |
| NPI Number: | 1700234580 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ANGELA REYNOLDS (CFO) |
| Mailing Address: | 65 Shenandoah Ave Suite 103 Daleville |
| State: | VA US |
| Postal Code: | 240833252 |
| Phone Number: | 5409666620 |
| Fax Number: | 5409666659 |
| NPI Enumeration Date: | 06/02/2016 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1200X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Magnetic Resonance Imaging (MRI) |
| Taxonomy Definition: | |