Provider Demographics
NPI:1619285079
Name:AN IV LLC
Entity Type:Organization
Organization Name:AN IV LLC
Other - Org Name:AN I.V., LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GIVHAN-SPEARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:901-489-6914
Mailing Address - Street 1:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38083-0217
Mailing Address - Country:US
Mailing Address - Phone:901-872-2648
Mailing Address - Fax:901-873-2650
Practice Address - Street 1:4565 SHELBY RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2295
Practice Address - Country:US
Practice Address - Phone:901-872-2648
Practice Address - Fax:901-873-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TN48163336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1522930Medicaid
MS07033005Medicaid
MS01072838Medicaid
2127119OtherPK