MEDICARE: NOVA SURGICAL SOLUTIONS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1003144817
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA SURGICAL SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	2326 BASTROP ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1402
Country	:	US
Telephone Number	:	713-817-3127
Fax Number	:	832-436-1726

Provider Business Practice Location Address
First Line	:	2326 BASTROP ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77004-1402
Country	:	US
Telephone Number	:	713-817-3127
Fax Number	:	832-436-1726

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. JOHN E ROKER JR.
Credential	:
Telephone Number	:	713-817-3127

Provider Enumeration Date	:	12/07/2009
Last Update Date	:	12/07/2009

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