1770248775 NPI number — DANVILLE PEDIATRICS MEDICAL GROUP PLLC

Table of content: (NPI 1770248775)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770248775 NPI number — DANVILLE PEDIATRICS MEDICAL GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DANVILLE PEDIATRICS MEDICAL GROUP PLLC
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:
1770248775
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
303 S 4TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40422-2091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-236-1080
Provider Business Mailing Address Fax Number:
859-236-1862

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1180 GLENSBORO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40342-9034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-598-3042
Provider Business Practice Location Address Fax Number:
502-598-3184
Provider Enumeration Date:
11/03/2021

Additional Information

Authorized Official

Authorized Official Last Name:
STRINGER
Authorized Official First Name:
JANET
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
859-236-1080

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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