Provider Demographics
NPI:1073614137
Name:DANVILLE ENT ASSOCIATES INC
Entity Type:Organization
Organization Name:DANVILLE ENT ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MEADEMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-792-0830
Mailing Address - Street 1:159 EXECUTIVE DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-4160
Mailing Address - Country:US
Mailing Address - Phone:434-792-0830
Mailing Address - Fax:434-792-0468
Practice Address - Street 1:159 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE C
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-4160
Practice Address - Country:US
Practice Address - Phone:434-792-0830
Practice Address - Fax:434-792-0468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA900652207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GACM2207OtherMEDICARE OF GA
VAC02123Medicare PIN