Healthcare Provider Details

I. General information

NPI: 1821509274
Provider Name (Legal Business Name): ANV SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2017
Last Update Date: 10/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 JAMES RAY DR
GRAND FORKS ND
58202-6026
US

IV. Provider business mailing address

2219 42ND AVE S
GRAND FORKS ND
58201-3488
US

V. Phone/Fax

Practice location:
  • Phone: 701-757-5132
  • Fax:
Mailing address:
  • Phone: 218-791-9247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR1100X
TaxonomyResearch Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DMITRI POLTAVSKI
Title or Position: CHIEF RESEARCH SCIENTIST
Credential: PH.D
Phone: 218-791-9247