1679573802 NPI number — DANNY W GNEWIKOW PH D LLC

Table of content: (NPI 1679573802)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679573802 NPI number — DANNY W GNEWIKOW PH D LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANNY W GNEWIKOW PH D LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1679573802
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
743 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24541-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-799-6288
Provider Business Mailing Address Fax Number:
434-797-3685

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
743 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24541-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-799-6288
Provider Business Practice Location Address Fax Number:
434-797-3685
Provider Enumeration Date:
07/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GNEWIKOW
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
434-799-6288

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  9720000078 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 59202 . This is a "SOUTHERN HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 148920200 . This is a "DEPARTMENT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 248032 . This is a "ANTHEM OF VA - DANVILLE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 10113944 . This is a "OPTIMA FAMILY" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9720000078 . This is a "BUSINESS LICENSE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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