1407886229 NPI number — NOVA INC.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407886229 NPI number — NOVA INC.

Employer Identification Number (EIN):

Provider Organization Name:

NOVA 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 Other Organization Name:

Provider Other Organization Name Type Code:

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:

1407886229

Entity Type Code:

Organization

Replacement NPI:

Last Update Date:

09/28/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 11147

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

GOLDSBORO

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27532-1147

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

919-734-8803

Provider Business Mailing Address Fax Number:

919-735-6825

Provider First Line Business Practice Location Address:

2002 SHACKLE FORD RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

KINSTON

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

28504-8917

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

252-233-0491

Provider Business Practice Location Address Fax Number:

252-233-0495

Provider Enumeration Date:

07/04/2006

Authorized Official Last Name:

PRIDGEN

Authorized Official First Name:

TRACEY

Authorized Official Middle Name:

Authorized Official Title or Position:

CFO

Authorized Official Telephone Number:

919-734-8803

• Taxonomy code: 322D00000X , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 322D00000X , with the licence number: NHL-054-013 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 323P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 6603000 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 8301286D , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6603013 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6603014 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6603006 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6603011 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 8300966 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 8300789B , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6005810 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 8300789H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 6603010 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".