Healthcare Provider Details

I. General information

NPI: 1356254692
Provider Name (Legal Business Name): NOVA MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 KAUFFMAN LOOP UNIT 310
GEORGETOWN TX
78628-1460
US

IV. Provider business mailing address

2021 KAUFFMAN LOOP UNIT 310
GEORGETOWN TX
78628-1460
US

V. Phone/Fax

Practice location:
  • Phone: 512-864-5648
  • Fax:
Mailing address:
  • Phone: 512-864-5648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. DORIAN K SHEVIZ
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: PA-C
Phone: 512-864-5648