Provider Demographics
NPI:1912050824
Name:DANVILLE MEDICAL SPECIALISTS
Entity type:Organization
Organization Name:DANVILLE MEDICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-236-6613
Mailing Address - Street 1:478 WHIRLAWAY DR
Mailing Address - Street 2:STE 100
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9037
Mailing Address - Country:US
Mailing Address - Phone:859-236-6613
Mailing Address - Fax:859-236-3558
Practice Address - Street 1:478 WHIRLAWAY DR
Practice Address - Street 2:STE 100
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9037
Practice Address - Country:US
Practice Address - Phone:859-236-6613
Practice Address - Fax:859-236-3558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty