Healthcare Provider Details

I. General information

NPI: 1508541392
Provider Name (Legal Business Name): NOVUS PENNSYLVANIA PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2023
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SOMERSET AVE
WINDBER PA
15963-1331
US

IV. Provider business mailing address

620 PEACHTREE ST NE STE 311
ATLANTA GA
30308-2355
US

V. Phone/Fax

Practice location:
  • Phone: 814-467-3000
  • Fax:
Mailing address:
  • Phone: 888-228-5798
  • 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