Provider Demographics
NPI:1154494342
Name:DAN J AILES MD INC
Entity type:Organization
Organization Name:DAN J AILES MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AILES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-454-4070
Mailing Address - Street 1:950 BETHESDA DR STE 5
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7507
Mailing Address - Country:US
Mailing Address - Phone:740-454-4070
Mailing Address - Fax:
Practice Address - Street 1:950 BETHESDA DR STE 5
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-7507
Practice Address - Country:US
Practice Address - Phone:740-454-4070
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000122315OtherPPOM CLAIMS
OH0782416Medicaid
OH=========OtherMMO
OH000000122315OtherPPOM CLAIMS
OH=========00OtherOHIO BWC
OH=========OtherTRICARE