Provider Demographics
NPI:1972964435
Name:AVERY TELEHEALTH, LLC
Entity Type:Organization
Organization Name:AVERY TELEHEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASPENSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-214-9052
Mailing Address - Street 1:8502 E PRINCESS DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-7802
Mailing Address - Country:US
Mailing Address - Phone:480-214-9052
Mailing Address - Fax:
Practice Address - Street 1:8502 E PRINCESS DR
Practice Address - Street 2:SUITE 260
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-7802
Practice Address - Country:US
Practice Address - Phone:480-214-9052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management