Provider Demographics
NPI:1225679129
Name:NOVA PAIN AND WELLNESS LLC
Entity Type:Organization
Organization Name:NOVA PAIN AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BELT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-527-0791
Mailing Address - Street 1:610 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1204
Mailing Address - Country:US
Mailing Address - Phone:602-527-0791
Mailing Address - Fax:
Practice Address - Street 1:610 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1204
Practice Address - Country:US
Practice Address - Phone:602-527-0791
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-01
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty