Provider Demographics
NPI:1396483178
Name:LEWISGALE MEDICAL CENTER, LLC
Entity type:Organization
Organization Name:LEWISGALE MEDICAL CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:HOKE
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-776-4125
Mailing Address - Street 1:1423 W RURITAN RD
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24012-6715
Mailing Address - Country:US
Mailing Address - Phone:540-945-9900
Mailing Address - Fax:
Practice Address - Street 1:1423 W RURITAN RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-6715
Practice Address - Country:US
Practice Address - Phone:540-945-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEWISGALE MEDICAL CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-23
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care