Provider Demographics
NPI:1518430925
Name:AINSLEY MEDICAL LLC
Entity Type:Organization
Organization Name:AINSLEY MEDICAL LLC
Other - Org Name:PRIMARY/URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:AINSLEY
Authorized Official - Last Name:INNIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-421-6180
Mailing Address - Street 1:1108 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-2940
Mailing Address - Country:US
Mailing Address - Phone:434-421-6180
Mailing Address - Fax:434-835-2689
Practice Address - Street 1:1108 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2940
Practice Address - Country:US
Practice Address - Phone:434-421-6180
Practice Address - Fax:434-235-2689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-08
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1740450220OtherUNITED HEALTH CARE
VA1740450220OtherANTHEM BCBS
VA1740450220Medicaid