MEDICARE: ANOVORX MANUFACTURER SERVICES, 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	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1477193399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANOVORX MANUFACTURER SERVICES, LLC

Provider Business Mailing Address
First Line	:	1710 SHELBY OAKS DR N STE 2
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7403
Country	:	US
Telephone Number	:	901-612-3281
Fax Number	:	901-201-5465

Provider Business Practice Location Address
First Line	:	1710 SHELBY OAKS DR N STE 3
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38134-7403
Country	:	US
Telephone Number	:	901-612-3281
Fax Number	:	901-201-5465

Authorized Official
Title or Position	:	CHIEF OPERATIONS OFFICER
Name	:	KYLE TRUITT
Credential	:
Telephone Number	:	901-201-5470

Provider Enumeration Date	:	01/08/2020
Last Update Date	:	01/08/2020

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