Healthcare Provider Details

I. General information

NPI: 1265124689
Provider Name (Legal Business Name): AINSLEY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 MAIN ST
DANVILLE VA
24541-2940
US

IV. Provider business mailing address

1108 MAIN ST
DANVILLE VA
24541-2940
US

V. Phone/Fax

Practice location:
  • Phone: 434-421-6180
  • Fax: 434-421-4974
Mailing address:
  • Phone: 434-421-6180
  • Fax: 434-421-4974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QE0002X
TaxonomyEmergency Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK AINSLEY INNIS
Title or Position: PHYSICIAN
Credential: MD
Phone: 434-421-6180