Healthcare Provider Details

I. General information

NPI: 1992379598
Provider Name (Legal Business Name): NOVUS IOWA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 S MAIN ST
CLARION IA
50525-2019
US

IV. Provider business mailing address

PO BOX 12766
PENSACOLA FL
32591-2766
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4321
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSHUA POOLE
Title or Position: PRESIDENT
Credential:
Phone: 404-285-8388