Provider Demographics
NPI:1215988589
Name:NOVA GROUP OF MEMPHIS, INC.
Entity type:Organization
Organization Name:NOVA GROUP OF MEMPHIS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BOSTON
Authorized Official - Suffix:SR
Authorized Official - Credentials:
Authorized Official - Phone:901-384-4775
Mailing Address - Street 1:6551 STAGE OAKS DR
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-3895
Mailing Address - Country:US
Mailing Address - Phone:901-384-4774
Mailing Address - Fax:901-384-4755
Practice Address - Street 1:6551 STAGE OAKS DR
Practice Address - Street 2:SUITE 4
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-3895
Practice Address - Country:US
Practice Address - Phone:901-384-4774
Practice Address - Fax:901-384-4755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1636339Medicaid
MS00702212Medicaid
TN1454942Medicaid
LA1636339Medicaid