Provider Demographics
NPI:1083024061
Name:AVERTEST, LLC
Entity Type:Organization
Organization Name:AVERTEST, LLC
Other - Org Name:AVERHEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-767-8693
Mailing Address - Street 1:2916 W MARSHALL ST STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23230-4811
Mailing Address - Country:US
Mailing Address - Phone:804-767-8693
Mailing Address - Fax:804-767-8693
Practice Address - Street 1:4709 LAGUARDIA DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63134
Practice Address - Country:US
Practice Address - Phone:314-665-2424
Practice Address - Fax:314-665-2424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1806261QR0405X
MO26D2037986291U00000X
MA22D2133374291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder