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General NPI Number Information
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NPI Number | 1508541392
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Entity Type | Organization
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Legal Business Name | NOVUS PENNSYLVANIA PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/19/2023
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 600 SOMERSET AVE
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City | WINDBER
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State | PA
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Zip | 15963-1331
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Country | US
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Telephone | 814-467-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 620 PEACHTREE ST NE STE 311
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City | ATLANTA
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State | GA
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Zip | 30308-2355
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Country | US
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Telephone | 888-228-5798
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOSHUA POOLE
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Credential |
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Telephone | 404-285-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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