Provider Demographics
NPI:1184700569
Name:DANVILLE ANESTHESIOLOGISTS INC
Entity type:Organization
Organization Name:DANVILLE ANESTHESIOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUKESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NIGAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:434-799-2375
Mailing Address - Street 1:635 MAIN STREET
Mailing Address - Street 2:JONES & ASSOCIATES
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541
Mailing Address - Country:US
Mailing Address - Phone:434-793-8555
Mailing Address - Fax:
Practice Address - Street 1:142 S MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-2922
Practice Address - Country:US
Practice Address - Phone:434-799-2375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1184700569Medicaid
NC01396OtherBLUE SHIELD
NC8901396Medicaid
VA2561OtherANTHEM BLUE CROSS
NC8901396Medicaid