Provider Demographics
NPI:1043427362
Name:DANVILLE PAIN MANAGEMENT AND REHABILITATION INSTITUTE, LLC.
Entity Type:Organization
Organization Name:DANVILLE PAIN MANAGEMENT AND REHABILITATION INSTITUTE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLO PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SATYANARAYANA
Authorized Official - Middle Name:GANAPATHI
Authorized Official - Last Name:RAJU
Authorized Official - Suffix:
Authorized Official - Credentials:DO, PHD
Authorized Official - Phone:217-442-3010
Mailing Address - Street 1:806 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:61832-3718
Mailing Address - Country:US
Mailing Address - Phone:217-442-3010
Mailing Address - Fax:217-442-3155
Practice Address - Street 1:806 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-3718
Practice Address - Country:US
Practice Address - Phone:217-442-3010
Practice Address - Fax:217-442-3155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
H52338Medicare UPIN