Healthcare Provider Details

I. General information

NPI: 1679114524
Provider Name (Legal Business Name): ANML LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2019
Last Update Date: 10/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1463 W MAIN ST UNIT P2
SALEM VA
24153-5525
US

IV. Provider business mailing address

3225 N FRANKLIN ST STE 2
CHRISTIANSBURG VA
24073-4003
US

V. Phone/Fax

Practice location:
  • Phone: 540-404-4555
  • Fax:
Mailing address:
  • Phone: 540-251-5002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State

VIII. Authorized Official

Name: JESSE C CORNWELL
Title or Position: OWNER
Credential:
Phone: 941-718-3138