1619213212 NPI number — ANOVORX GROUP LLC

Table of content: (NPI 1619213212)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619213212 NPI number — ANOVORX GROUP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANOVORX GROUP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619213212
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1710 SHELBY OAKS DR N
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38134-7403
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-201-5470
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 SHELBY OAKS DR N
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38134-7403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-201-5470
Provider Business Practice Location Address Fax Number:
901-201-5465
Provider Enumeration Date:
12/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
PETERS
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER/PRESIDENT
Authorized Official Telephone Number:
901-201-5484

Provider Taxonomy Codes

  • Taxonomy code: 3336S0011X , with the licence number:  1314 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3336S0011X , with the licence number: A9-0001296 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 64001473A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 054.018178 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: OSP.0006189 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PMP.833 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: Y005790 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 34084MS , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PHNR000415 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 4155 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NRP1461 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PH27151 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: PCN.0002570 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: NRX0000453 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336S0011X , with the licence number: 22-13044 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00320857 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100263994-00 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 92003354 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0422371 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079196200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201202520A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 500671090 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023188 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200528380A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 202561407 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161796 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1619213212 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".




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