=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417806068
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NOVENZA PRACTICE GROUP II
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2026
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1200 N STATE ROAD 135
-----------------------------------------------------
City | GREENWOOD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46142-1003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-798-5688
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5995 CLAYBOURNE DR
-----------------------------------------------------
City | BARGERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46106-8393
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCE OFFICER
-----------------------------------------------------
Name | SARA SPARKS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 812-798-5688
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0300X
-----------------------------------------------------
Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------