1821038696 NPI number — DANVILLE ANESTHESIA ASSOCIATES, LLP

Table of content: (NPI 1821038696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821038696 NPI number — DANVILLE ANESTHESIA ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE ANESTHESIA ASSOCIATES, LLP
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:
1821038696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27766
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-2029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-907-0356
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 S 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40422-1823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-239-1000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/08/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BUX
Authorized Official First Name:
ANJUM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
859-236-3726

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 152143KYIP . This is a "AETNA BETTER HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100200450 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00000063397 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100200460 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".