Healthcare Provider Details

I. General information

NPI: 1265191621
Provider Name (Legal Business Name): AVERTEST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2021
Last Update Date: 08/15/2022
Certification Date: 08/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W MAXWELL ST
LEXINGTON KY
40508-2508
US

IV. Provider business mailing address

2916 W MARSHALL ST STE 100
RICHMOND VA
23230-4808
US

V. Phone/Fax

Practice location:
  • Phone: 866-680-3106
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MELISSA FRANZUA RIOS
Title or Position: SR. PAYER RELATIONS ASSOCIATE
Credential:
Phone: 804-500-9813