MEDICARE: NUVATION HEALTH SERVICES P.C.

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	101YM0800X	Mental Health Counselor	2899	ND
2	101Y00000X	Counselor

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	119426	OTHER		HEALTH PARTNERS

General Provider Information

NPI Number	:	1982754552
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NUVATION HEALTH SERVICES P.C.

Provider Business Mailing Address
First Line	:	600 SOUTH 2ND ST
Second Line	:	SUITE 201
City	:	BISMARCK
State	:	ND
Zip	:	58504-5729
Country	:	US
Telephone Number	:	701-258-3780
Fax Number	:	701-258-6431

Provider Business Practice Location Address
First Line	:	600 SOUTH 2ND ST
Second Line	:	SUITE 201
City	:	BISMARCK
State	:	ND
Zip	:	58504-5729
Country	:	US
Telephone Number	:	701-258-3780
Fax Number	:	701-258-6431

Authorized Official
Title or Position	:	PARTNER-AUTHORIZED SIGNATURE
Name	:	MS. THERESA ANN PORTER
Credential	:	LICSW
Telephone Number	:	701-391-7968

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	03/03/2010

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