1710266820 NPI number — AILEEN DANKO MD LLC

Table of content: (NPI 1710266820)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710266820 NPI number — AILEEN DANKO MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AILEEN DANKO MD 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:
6
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:
1710266820
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39046-1549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-407-6104
Provider Business Mailing Address Fax Number:
601-407-6074

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 W PEACE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39046-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-407-6104
Provider Business Practice Location Address Fax Number:
601-407-6074
Provider Enumeration Date:
08/06/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DANKO
Authorized Official First Name:
AILEEN
Authorized Official Middle Name:
MARIE
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
601-407-6104

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  ME 85303 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 265207200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009335095 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com