MEDICARE: NOVA GROUP OF MEMPHIS, INC.

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215988589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA GROUP OF MEMPHIS, INC.

Provider Business Mailing Address
First Line	:	6551 STAGE OAKS DR
Second Line	:	SUITE 4
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-384-4774
Fax Number	:	901-384-4755

Provider Business Practice Location Address
First Line	:	6551 STAGE OAKS DR
Second Line	:	SUITE 4
City	:	BARTLETT
State	:	TN
Zip	:	38134-3895
Country	:	US
Telephone Number	:	901-384-4774
Fax Number	:	901-384-4755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. PAUL MICHAEL BOSTON SR.
Credential	:
Telephone Number	:	901-384-4775

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	08/22/2020

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