Provider Demographics
NPI:1821509274
Name:ANV SERVICES LLC
Entity Type:Organization
Organization Name:ANV SERVICES LLC
Other - Org Name:ADVANCED NEURO-VISION SYSTEMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF RESEARCH SCIENTIST
Authorized Official - Prefix:
Authorized Official - First Name:DMITRI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLTAVSKI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:218-791-9247
Mailing Address - Street 1:2219 42ND AVE S
Mailing Address - Street 2:
Mailing Address - City:GRAND FORKS
Mailing Address - State:ND
Mailing Address - Zip Code:58201-3488
Mailing Address - Country:US
Mailing Address - Phone:218-791-9247
Mailing Address - Fax:
Practice Address - Street 1:4201 JAMES RAY DR
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58202-6026
Practice Address - Country:US
Practice Address - Phone:701-757-5132
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
No261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1518045921OtherNPI