Provider Demographics
NPI:1265124689
Name:AINSLEY MEDICAL LLC
Entity type:Organization
Organization Name:AINSLEY MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
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:434-421-4974
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:434-421-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-24
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty