1588683742 NPI number — NOVA MEDICAL AND URGENT CARE CENTER, INC.

Table of content: (NPI 1588683742)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588683742 NPI number — NOVA MEDICAL AND URGENT CARE CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA MEDICAL AND URGENT CARE CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NOVA MEDICAL GROUP, NOVA URGENT CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1588683742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 37227
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21297-3227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-554-1120
Provider Business Mailing Address Fax Number:
703-554-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21785 FILIGREE CT
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
ASHBURN
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20147-6213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-554-1100
Provider Business Practice Location Address Fax Number:
703-554-1110
Provider Enumeration Date:
07/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MARSHAK
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGING EMPLOYEE
Authorized Official Telephone Number:
703-554-1120

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ND0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DD5411 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".