Provider Demographics
NPI:1306361977
Name:NOMAD MEDICAL
Entity Type:Organization
Organization Name:NOMAD MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHELA
Authorized Official - Middle Name:Q
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-644-3483
Mailing Address - Street 1:7952 E CARIBOU PL
Mailing Address - Street 2:
Mailing Address - City:BEL AIRE
Mailing Address - State:KS
Mailing Address - Zip Code:67226-7674
Mailing Address - Country:US
Mailing Address - Phone:316-644-3483
Mailing Address - Fax:316-616-2095
Practice Address - Street 1:7952 E CARIBOU PL
Practice Address - Street 2:
Practice Address - City:BEL AIRE
Practice Address - State:KS
Practice Address - Zip Code:67226-7674
Practice Address - Country:US
Practice Address - Phone:316-644-3483
Practice Address - Fax:316-616-2095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-04
Last Update Date:2017-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5377066251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201131200BMedicaid