MEDICARE: NOVIS CORPORATION

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
2	335E00000X	Prosthetic/Orthotic Supplier	1433	MN
3	335E00000X	Prosthetic/Orthotic Supplier	C17444	MD

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

General Provider Information

NPI Number	:	1306820873
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVIS CORPORATION

Provider Business Mailing Address
First Line	:	1712 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3012
Country	:	US
Telephone Number	:	415-440-0444
Fax Number	:	415-440-0441

Provider Business Practice Location Address
First Line	:	1712 DIVISADERO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-3012
Country	:	US
Telephone Number	:	415-440-0444
Fax Number	:	415-440-0441

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GARY VAYSBERG
Credential	:	CPED
Telephone Number	:	415-440-0444

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	09/11/2025

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Directions to “NOVIS CORPORATION ” Practice Location

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