MEDICARE: AVERTEST LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1265191621
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVERTEST LLC

Provider Business Mailing Address
First Line	:	2916 W MARSHALL ST STE 100
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23230-4808
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W MAXWELL ST
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40508-2508
Country	:	US
Telephone Number	:	866-680-3106
Fax Number	:

Authorized Official
Title or Position	:	SR. PAYER RELATIONS ASSOCIATE
Name	:	MELISSA FRANZUA RIOS
Credential	:
Telephone Number	:	804-500-9813

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	08/15/2022

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Directions to “AVERTEST LLC ” Practice Location

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