MEDICARE: CLOVIS AI

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
2	207RX0202X	Medical Oncology Physician

General Provider Information

NPI Number	:	1518834167
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLOVIS AI

Provider Business Mailing Address
First Line	:	PO BOX 548
Second Line	:
City	:	SIMPSONVILLE
State	:	SC
Zip	:	29681-0548
Country	:	US
Telephone Number	:	321-626-6164
Fax Number	:	888-877-3919

Provider Business Practice Location Address
First Line	:	2441 BELLEVUE AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5615
Country	:	US
Telephone Number	:	772-475-2277
Fax Number	:	888-877-3919

Authorized Official
Title or Position	:	CFO
Name	:	GARRETT SOWARDS
Credential	:
Telephone Number	:	321-626-6164

Provider Enumeration Date	:	10/20/2025
Last Update Date	:	01/10/2026

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Directions to “CLOVIS AI ” Practice Location

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