MEDICARE: NOMAD IV 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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1265372874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOMAD IV LLC

Provider Business Mailing Address
First Line	:	699 GINGERMILL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1917
Country	:	US
Telephone Number	:	606-367-3681
Fax Number	:

Provider Business Practice Location Address
First Line	:	699 GINGERMILL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1917
Country	:	US
Telephone Number	:	606-367-3681
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TREVOR JAMES STOVALL
Credential	:	RN
Telephone Number	:	606-367-3681

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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