Provider Demographics
NPI:1508077603
Name:DANVILLE PHYSICIAN PRACTICES, LLC
Entity Type:Organization
Organization Name:DANVILLE PHYSICIAN PRACTICES, LLC
Other - Org Name:FAMILY HEALTHCARE CENTERS OF GRETNA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:305 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-4176
Mailing Address - Country:US
Mailing Address - Phone:434-656-2224
Mailing Address - Fax:
Practice Address - Street 1:305 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-4176
Practice Address - Country:US
Practice Address - Phone:434-656-2224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2022-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA49-3836261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA493836Medicare ID - Type UnspecifiedRURAL HEALTH PROVIDER NUM