1619213212 NPI number — ANOVORX GROUP LLC

NPI Number: 1619213212
Health Care Provider/Practitioner: ANOVORX GROUP LLC

NPI Number : 1619213212 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619213212",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "ANOVORX GROUP LLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1710 SHELBY OAKS DR N",
    "SecondLineMailingAddress": "SUITE 2",
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38134-7403",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-201-5470",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1710 SHELBY OAKS DR N",
    "SecondLinePracticeLocationAddress": "SUITE 1",
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38134-7403",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-201-5470",
    "PracticeLocationAddressFaxNumber": "901-201-5465",
    "EnumerationDate": "12/31/2012",
    "LastUpdateDate": "11/28/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "PETERS",
    "AuthorizedOfficialFirstName": "JON",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "MANAGING MEMBER/PRESIDENT",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "901-201-5484",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "OSP.0006189",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "PMP.833",
          "LicenseNumberStateCode": "HI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "Y005790",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "A9-0001296",
          "LicenseNumberStateCode": "DE",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "64001473A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "054.018178",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "34084MS",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "PHNR000415",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "4155",
          "LicenseNumberStateCode": "IA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "NRP1461",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "PH27151",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "PCN.0002570",
          "LicenseNumberStateCode": "CT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "NRX0000453",
          "LicenseNumberStateCode": "DC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "22-13044",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "3336S0011X",
          "TaxonomyName": "Specialty Pharmacy",
          "LicenseNumber": "1314",
          "LicenseNumberStateCode": "AK",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}