Provider Demographics
NPI:1366946832
Name:NOVA HEALTH MEDICAL GROUP, LLC
Entity type:Organization
Organization Name:NOVA HEALTH MEDICAL GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:WRIGHT
Authorized Official - Last Name:MOUNTJOY
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:573-499-6540
Mailing Address - Street 1:3208 LEMONE INDUSTRIAL BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8244
Mailing Address - Country:US
Mailing Address - Phone:573-499-6541
Mailing Address - Fax:
Practice Address - Street 1:3208 LEMONE INDUSTRIAL BLVD STE A
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8244
Practice Address - Country:US
Practice Address - Phone:573-499-6541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-20
Last Update Date:2022-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty