MEDICARE: AVIANT HEALTH 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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1841726403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AVIANT HEALTH LLC

Provider Business Mailing Address
First Line	:	2920 W BROAD ST
Second Line	:	SUITE 218
City	:	RICHMOND
State	:	VA
Zip	:	23230-5103
Country	:	US
Telephone Number	:	804-317-6462
Fax Number	:

Provider Business Practice Location Address
First Line	:	2920 W BROAD ST
Second Line	:	SUITE 218
City	:	RICHMOND
State	:	VA
Zip	:	23230-5103
Country	:	US
Telephone Number	:	804-317-6462
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ANNA K MCKEAN
Credential	:	MBA
Telephone Number	:	804-317-6462

Provider Enumeration Date	:	05/02/2017
Last Update Date	:	05/02/2017

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Directions to “AVIANT HEALTH LLC ” Practice Location

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