MEDICARE: NOVA ORTHOPEDIC CLINIC INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	335E00000X	Prosthetic/Orthotic Supplier

General Provider Information

NPI Number	:	1003829227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA ORTHOPEDIC CLINIC INC

Provider Business Mailing Address
First Line	:	1420 SW 1ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2203
Country	:	US
Telephone Number	:	305-545-7777
Fax Number	:	305-545-8163

Provider Business Practice Location Address
First Line	:	1420 SW 1ST ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33135-2203
Country	:	US
Telephone Number	:	305-545-7777
Fax Number	:	305-545-8163

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. CHRISTOPHER J LEYVA
Credential	:
Telephone Number	:	305-545-7777

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	02/15/2016

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